脊髓损伤的初始出血控制程序可能会影响静脉血栓栓塞的风险
Nicole B Lyons1, Christopher F O'Neil1, Walter A Ramsey1
1Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, and Ryder Trauma Center, Miami, Florida.
The Journal of surgical research
|May 23, 2024
概括
与切除术相比,血管栓塞显著降低了创伤患者的静脉血栓栓塞 (VTE) 风险,这些患者有高度的形脏损伤. 这种不那么侵入性的方法提供了更好的结果,包括更短的住院时间和更低的死亡率.
科学领域:
- 创伤外科 手术 创伤外科
- 血管外科 血管外科
- 外科手术的结果
背景情况:
- 静脉血栓塞栓症 (VTE) 是创伤患者的一个重大并发症.
- 脊髓损伤的脊髓切除术和血管栓塞之间的静脉瘤风险的比较并未得到充分确立.
研究的目的:
- 为了调查高度形脏损伤的血管栓塞是否与与切除术相比较较低的VTE率有关.
- 评估出血控制程序对创伤中静脉瘤发病率的影响.
主要方法:
- 美国外科医生学院创伤质量计划数据集 (2017-2019) 的分析.
- 包括美国创伤外科协会 (American Association for the Surgery of Trauma) 3-5级形骨损伤的患者.
- 使用倾向性得分匹配的脊髓切除术和血管栓塞组之间的VTE率的比较.
主要成果:
- 与切除术 (3.4%,P=0.010) 相比,血管栓塞与明显较低的VTE率 (2.2%) 相关.
- 这一发现在血管栓塞组中仍然存在,尽管在血管栓塞组中VTE化学预防的频率较低,并且延迟.
- 血管栓塞还表明,住院和ICU的住院时间减少,死亡率降低.
结论:
- 血管栓塞与血液动力学稳定的高度形脏损伤患者的静脉瘤发病率较低有关.
- 血管栓塞应被视为这些患者的初始治疗策略.
- 这种方法可以改善患者的治疗结果,并减少静脉瘤并发症.
相关概念视频
01:28Esophageal Varices-II: Clinical Features and Management
60
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
60
01:20Extrinsic and Intrinsic Pathways of Hemostasis
7.2K
Blood clotting or coagulation involves extrinsic and intrinsic pathways, which ultimately merge into the common pathway, forming a fibrin clot.
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...
7.2K
01:05Introduction to Hemostasis
7.3K
Hemostasis is a complex physiological process that prevents excessive bleeding when a blood vessel is injured. It's crucial for maintaining the integrity of the circulatory system, as it ensures that our blood remains fluid while still within the vascular network and yet clots to prevent blood loss upon vessel injury.
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized,...
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized,...
7.3K
01:16Vascular Spasm
1.4K
The vascular phase, also known as vasospasm, is the initial stage of hemostasis, crucial for preventing excessive bleeding when a blood vessel is injured. After a vessel is cut, nerves in the damaged area trigger pain and other sensory impulses. Simultaneously, the smooth muscles in the vessel wall contract, resulting in a vascular spasm. This contraction reduces the vessel's diameter at the injury site, slowing or stopping blood loss through the vessel wall. Vascular spasms typically last...
1.4K
01:24Disorders of Hemostasis
845
Hemostasis, the process that stops bleeding after a blood vessel injury, is crucial for maintaining the integrity of the circulatory system. However, disorders of hemostasis can disrupt this delicate balance, leading to either excessive clotting or bleeding. These disorders can be broadly classified into thromboembolic disorders and bleeding disorders.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
845
01:24Esophageal Varices-I: Introduction
111
Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
111