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在左心室辅助器件植入装置中预测外科手术期间出血的预测因素
Mohammed Elzeneini1, Ahmad Mahmoud2, Abdelrahman H Elsayed3
1Department of Internal Medicine, University of Florida, Gainesville, FL, USA.
概括
左心室辅助装置 (LVAD) 植入后早期出血的预测因素包括先前的椎切除术,低膜过率,高右心房压力和三膜修复. 优化右心房压力可能会降低出血风险.
科学领域:
- 心血管外科心血管外科
- 医疗器械 医疗器械
- 血并发症 血并发症
背景情况:
- 早期出血是左心室辅助器件 (LVAD) 植入后的一个重大并发症,导致患者的发病率.
- 识别植入周边出血的预测因素对于改善患者的治疗结果和外科手术策略至关重要.
研究的目的:
- 在接受LVAD植入的患者中确定术后出血的独立预测因子.
- 为了告知患者的植入前优化策略,以减轻出血风险.
主要方法:
- 210名LVAD植入患者的回顾性队列研究 (2010年1月 - 2018年11月).
- 数据收集包括外科手术期间的血液动力学,心声学,手术细节,药物使用以及出血/血栓塞栓事件.
- 术后出血定义为>4单位PRBC输血或需要在植入后7天内进行干预的重大出血.
主要成果:
- 术后出血发生在32%的患者中,9%的患者需要重新进行手术.
- 独立预测出血的预测因素:先前的胸切除术 (OR 2.63),GFR <60毫升/分钟 (OR 2.58),右心房压力>13毫米升 (OR 2.36) 和三管修复 (OR 2.48).
- 没有发现医院内血栓栓塞事件的显著预测因子 (发病率5%).
结论:
- 右心房压升高是LVAD后早期出血的可修改风险因素.
- 在LVAD候选人中,对右心房压的植入前优化可能会减少手术期间出血的发生率.
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