关于肝硬化侵袭性手术导致出血风险的专家意见
Alix Riescher-Tuczkiewicz1, Stephen H Caldwell2, Patrick S Kamath3
1Université Paris-Cité, Inserm, Centre de recherche sur l'inflammation, UMR 1149, Paris, France.
JHEP reports : innovation in hepatology
|February 22, 2024
概括
专家们就肝硬化患者的侵入性手术出血风险达成共识. 确定了血小板计数值,低风险手术可接受在30×10^9/L,高风险在50×10^9/L.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 胃肠病学 胃肠病学
- 干预医学是干预的医学.
背景情况:
- 缺乏关于血液出血风险和肝硬化患者侵入性手术的安全门的共识.
- 现有的国际指南为管理这些患者提供了相互矛盾的建议.
研究的目的:
- 在肝硬化患者的侵入性手术中制定关于出血风险的立场论文.
- 在程序之前定义实验室参数安全值的专家共识.
主要方法:
- 调查了52名参与国际肝硬化患者程序指南的专家.
- 专家将80种手术分类为高或低出血风险 (≥1.5%大出血风险).
- 确定了关于安全程序执行可接受的实验室测试值的共识 (≥75%的协议).
主要成果:
- 在80项手术中,共达52项 (65%) 的共识:有17项高风险和35项低风险.
- 最低可接受的血小板数量: 30×10^9/L (低风险) 和 50×10^9/L (高风险/手术).
- 专家们普遍认为,国际规范化比率 (INR) 对低风险手术而不是对高风险手术至关重要.
结论:
- 基于专家的分类为改进未来研究设计提供了一个框架.
- 这些发现指导了对肝硬化患者的侵入性手术的临床决策.
- 关于血小板计数和INR值的共识使医生在手术前了解可接受的实验室值.
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