在神经内血管手术过程中评估血液损失
Michael Goutnik1, Andrew Nguyen1, Chance Fleeting1
1Department of Neurosurgery, University of Florida, Gainesville, FL 32601, USA.
Journal of clinical medicine
|February 10, 2024
概括
神经内血管干预会导致比以前想象的更多的血液损失,特别是在老年患者或服用抗血小板/抗凝血药物的患者中. 诊断性血管图显示血流量最小,而治疗程序需要更密切地监测出血风险.
科学领域:
- 神经学 神经学
- 血管外科 血管外科
- 干预性放射学 干预性放射学
背景情况:
- 人们普遍认为神经内血管程序会导致最小的血液损失.
- 之前的研究还没有量化这些干预措施中的血液损失.
- 这项研究量化了血液损失,并确定了相关的危险因素.
研究的目的:
- 在神经内血管程序期间量化血液损失.
- 用血红蛋白变化作为替代品来识别血液损失的预测因素.
- 为了区分诊断和治疗干预措施之间的血液损失.
主要方法:
- 200次连续的神经内血管手术的回顾性审查 (2020年1月至10月).
- 纳入标准:手术前和手术后的血红蛋白/血红素在48小时内.
- 血红蛋白降低是血液损失的主要指标.
主要成果:
- 诊断血管图的平均血红蛋白降低为0.5g/dL,而内血管干预的平均降低为1.2g/dL (p < 0.0001).
- 总体平均血红蛋白降低为1.0g/dL.
- 多变量分析确定了手术前的抗血小板/抗凝剂使用是增加血液损失的显著预测因素.
结论:
- 诊断血管图的血液损失通常是边际的.
- 内血管干预与明显更高的血液损失有关.
- 增加年龄和手术前使用抗血小板/抗凝剂预测出血风险更高,因此需要对患者进行更密切的监测.
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