在创伤性椎脊髓损伤后的手术脊柱方法和气管切除术时间之间的关联量化
Ahmad Essa1,2,3, Husain Shakil1,4, Armaan K Malhotra1,4
1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto , Ontario , Canada.
Neurosurgery
|March 8, 2024
概括
对于椎脊髓损伤 (SCI) 患者的早期气管切除术可以减少并发症和住院时间. 手术方法不会影响这种益处,无论SCI治疗方法如何,都强调及时进行气管切除术.
科学领域:
- 神经外科 神经外科
- 创伤外科 手术 创伤外科
- 关键护理医学 关键护理医学
背景情况:
- 完全椎脊髓损伤 (SCI) 带来了重大管理挑战.
- 早期气管切除术越来越多地被认为具有降低SCI患者并发症的潜力.
- 外科手术对气管切除术时间和SCI的结果的影响尚未完全理解.
研究的目的:
- 评估脊柱外科手术方法对气管管切除术时间和住院不良事件之间的关联的影响.
- 确定手术方法是否改变了在完全宫SCI的早期气管切除术的好处.
- 分析气管切除术时间和主要并发症,不动性相关问题和资源利用之间的关系.
主要方法:
- 使用创伤质量改善计划数据 (2017-2020) 进行回顾性队列研究.
- 包括患有急性完全 (美国脊椎损伤协会-A) 宫SCI的患者,接受气管切除和脊椎手术.
- 气管切除术时间分类为早期 (≤1周) 或延迟 (>1周) 手术后.
主要成果:
- 早期气管切除术显著减少了主要的住院并发症 (OR 0.67) 和不运动并发症 (OR 0.78).
- 早期气管切除术的患者在医院住院时间更短,ICU住院时间更短,机械通风持续时间更短.
- 手术方法 (前部,后部或组合) 并没有显著改变早期气管切除术对结果的好处.
结论:
- 在宫SCI患者的早期气管切除术与更少的并发症和减少资源利用有关.
- 早期气管切除术的好处独立于用于SCI治疗的手术方法.
- 根据所选择的SCI手术策略,气管切除术不应推迟.
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