术后早期的全身性炎症反应作为食道切除术后异位体泄漏的预测因素:系统性审查和元分析
Elke Van Daele1, Hanne Vanommeslaeghe1, Louise Peirsman1
1Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium.
概括
C-反应蛋白 (CRP) 是一个有价值的生物标志物,用于预测食道切除术后的异位性泄漏. 在第二天,CRP水平低于222 mg/L,表明泄漏风险低,使患者能够安全康复.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 关键护理医学 关键护理医学
背景情况:
- 消化管切除术后的门泄漏是致病率和死亡率的重要原因.
- 早期发现泄漏对于及时干预和改善患者结果至关重要.
- 目前的生物标志物,如C反应蛋白 (CRP),白细胞计数,白蛋白和Noble-Underwood (NUn) 评分,用于预测泄漏.
研究的目的:
- 为了评估炎症生物标志物的诊断准确性,以预测食道切除术后的解剖学泄漏.
- 为了确定可靠的生物标志物,用于早期检测和管理道泄漏.
- 评估CRP水平和NUn得分在预测食道切除术后泄漏的有用性.
主要方法:
- 按照PRISMA指南进行系统审查和元分析.
- 在主要数据库 (PubMed,MEDLINE,Web of Science,Embase) 进行独立的文献搜索.
- 评估偏见来源和对收集数据进行元分析的表现.
主要成果:
- 分析了来自5348名患者的数据,泄漏率为13%.
- 在手术后的第二天到第五天,C-反应蛋白 (CRP) 显示出良好的诊断准确性.
- 在第二天的最佳CRP截止值 (<222 mg/L) 显示高灵敏度 (81%) 和特异性 (88%) 预测没有泄漏. NUn的得分显示准确度很差.
结论:
- 诺布尔-安德伍德 (NUn) 评分缺乏足够的准确性来预测食道切除术后的泄漏.
- 血清CRP水平是一个可靠的阴性预测器的anastomotic泄漏.
- 第二天CRP水平<222 mg/L表明泄漏风险低,支持持续增强的恢复协议. 在第5天的CRP水平<127 mg/L可能允许患者安全出院.
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