在患有急性心肌梗塞和呼吸系统衰竭的患者中进行气管切除术
Megan Grammatico1, Soumya Banna1, Andi Shahu2
1Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
Journal of intensive care medicine
|May 8, 2024
概括
对于需要机械呼吸的急性心肌梗塞患者,气管切除术是常见的. 在气管切除术期间继续双重抗血小板治疗 (DAPT) 与较低的死亡率有关,这表明它不应该推迟该程序.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 关键护理医学 关键护理医学
背景情况:
- 患有急性心肌梗塞 (AMI) 和呼吸衰竭的患者往往需要机械呼吸,可能需要气管切除术.
- 抗血小板治疗对于AMI至关重要,但可能会增加气管切除术的出血风险.
- 关于气管切除术发生率和抗血小板治疗对AMI患者结局的影响的数据有限.
研究的目的:
- 确定需要侵入性机械通风 (IMV) 的AMI患者中气管切除术的发生率.
- 评估气管切除术时间对患者结果的影响.
- 评估双重抗血小板治疗 (DAPT) 使用与这种患者群体的住院死亡率之间的关联.
主要方法:
- 利用Vizient®临床数据库 (2015-2019) 来识别需要IMV的AMI患者.
- 评估了气管切除术发生率,根据时间分层结果 (≤10 vs >10天),并分析了DAPT与死亡率的相关性.
- 包括18岁及以上的患者,初级诊断为AMI.
主要成果:
- 确定了26435名需要IMV的AMI患者;6.0%接受了气管切除术.
- 气管切除术发生在12天的中位数,超过90%在10天后进行.
- 在气管切除术当天继续使用DAPT与显著降低住院死亡率有关 (17.4%与23.7%,P=0.01) 并在多变量调整后保持显著 (OR 0.68;95%CI:0.49-0.94,P=0.02).
- 气管切除术时间没有显著影响死亡率 (22.5%对22.8%,P=0.94).
- 使用DAPT与气管切除术后输血增加有关 (5.6%对2.7%,P=0.01).
结论:
- 大约在每20名被直管的AMI患者中,大约有1名需要进行气管切除术.
- 在气管切除术期间继续使用DAPT,而不是手术的时间,与减少住院死亡率有关.
- 在AMI患者中,DAPT不应被认为是及时气管切除术的禁忌.
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