肝切除术后异常凝血在正常的手术前凝血功能患者
Liting Kuang1, Weibin Lin2, Dahui Wang1
1Department of Anesthesiology, the First Afflicted Hospital of Sun Yet-sen University, Guangzhou, 510080, China.
BMC surgery
|May 6, 2024
概括
手术后异常凝血 (PAC) 影响超过一半的肝切除术患者. 关键的风险因素包括手术前的国际正常化比率 (INR),手术内液体输液和主要肝切除术,使得预测模型的开发成为可能.
科学领域:
- 肝胆道手术 肝胆道手术
- 凝血医学 凝血医学
- 手术风险评估手术风险评估
背景情况:
- 手术后异常凝血 (PAC) 是肝切除术后的一个重大并发症.
- 识别风险因素对于患者的管理和结果至关重要.
- 预测模型可以帮助风险患者进行早期干预.
研究的目的:
- 在接受肝切除术的患者中识别术后异常凝血 (PAC) 的危险因素.
- 开发和验证在患有正常手术前凝血的患者中对PAC的预测模型.
- 改善肝脏手术后的临床决策和患者护理.
主要方法:
- 对661名接受肝切除术并进行正常手术前凝血的患者进行了回顾性分析.
- 单变量和多变量逻辑回归,包括LASSO分析,以确定风险因素.
- 为PAC构建和验证基于名录的预测模型.
主要成果:
- 在研究队列中,PAC的发病率为54.8%.
- 手术前的国际正常化比率 (INR),手术内苏西尼尔凝输液量和主要肝切除术被确定为独立的风险因素.
- 预测模型表现良好,ROC曲线为0.742 (培训) 和0.711 (验证).
结论:
- PAC与手术前的INR,手术内流体管理和手术程度有显著的关联.
- 一个经过验证的三因素预测模型可以有效地识别肝切除术后患有PAC风险的患者.
- 该模型为风险分层和个性化的术后护理提供了有价值的工具.
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