术后托罗素监测以检测心肌梗塞:一个观察性队列建模研究
Selene Martinez-Perez1, Judith A R van Waes2, Lisette M Vernooij3
1Department of Anesthesiology and Pain Management, Toronto General Hospital/University Health Network Toronto, Toronto, ON, Canada.
British journal of anaesthesia
|January 17, 2024
概括
一个新的风险分层模型优化选择患者进行术后心肌梗塞 (POMI) 监测,减少不必要的查. 这种方法提高了诊断的准确性,并降低了与现有指导方针相比,查所需的数量.
科学领域:
- 心脏病学 心脏病学
- 临床医学 临床医学
- 医学诊断 医学诊断 医学诊断
背景情况:
- 手术后心肌梗塞 (POMI) 通常是无声的.
- 国际指导方针建议在风险患者中进行常规的托罗尼监测.
- 目前的指导方针"在非心脏手术后对患者进行监测的选择有所不同.
研究的目的:
- 为了比较美国,加拿大和欧洲对激素监测指南的患者选择疗效.
- 根据本指南,对已建立的风险分层模型进行评估.
- 为了确定POMI监测的最佳患者选择.
主要方法:
- 利用了来自METS和TEAMS前性研究 (2350名患者) 的结果数据.
- 将指南建议与专有风险分层模型进行比较.
- 量化患者人数,POMI检测率,灵敏度,特异性,诊断几率比,以及查所需人数 (NNS).
主要成果:
- 风险分层模型确定了较少的患者需要监测 (20%) 与加拿大 (78%) 和欧洲 (79%) 准则相比.
- 加拿大和欧洲的指导方针显示POMI检测的最高灵敏度为 (0.85).
- 风险模型实现了优异的诊断几率比率 (2.5) 和较低的NNS (21).
结论:
- 加拿大和欧洲的指导方针检测到大多数POMI,但具有较低的特异性和高的查数量.
- 建立的风险分层模型为POMI监测提供了最佳的患者选择.
- 基于风险的选择提高了诊断效率,减少了不必要的查.
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