脆弱对心脏手术后结果的影响
Abhilasha Ahuja1, Thomas Baker2, Mahesh Ramanan3
1Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia; School of Medicine, The University of Queensland, St Lucia, Queensland, Australia.
The Journal of thoracic and cardiovascular surgery
|June 13, 2024
概括
通过临床虚弱度量衡量的虚弱度增加,显著增加了接受心脏手术的患者在医院死亡的风险. 虚弱的患者也面临更长的住院时间和更高的并发症率,如脏替代疗法.
科学领域:
- 心脏病学 心脏病学
- 老年医学 老年医学
- 外科手术的结果
背景情况:
- 脆弱性是老年医学中日益关注的问题,影响了外科手术的结果.
- 评估脆弱性对于接受重大手术的老年患者的风险分层至关重要.
研究的目的:
- 调查临床虚弱度尺度量化的虚弱度增加与心脏手术患者的医院死亡率之间的关联.
- 探索心脏手术后的脆弱性和二次不良结果之间的关系.
主要方法:
- 一项回顾性双国队列研究包括46,928名在澳大利亚和新西兰接受心脏手术的患者.
- 使用临床脆弱度量 (CFS) 评估脆弱性,将患者分为脆弱 (CFS 5-8) 或非脆弱 (CFS 1-4).
- 采用多变量,混合效应的后勤回归模型来分析脆弱性和结果之间的关联.
主要成果:
- 6.7%的患者被归类为脆弱 (n=3122).
- 与非虚弱患者相比,虚弱患者的住院死亡率明显高 (4.2%对1.05%).
- 在多变量调整后,虚弱仍然是增加医院死亡率 (OR 2.879,P < .001) 的强有力的预测因素,并且与更长的住院/ICU停留时间,增加的通风时间以及更高的置换疗法和气管切除率有关.
结论:
- 通过临床虚弱度量衡量的虚弱度增加与接受心脏手术的患者在医院死亡率的增加密切相关.
- 脆弱性独立地预测了不良结果,包括长时间住院和重症监护室,增加对侵入性通风的需求,脏替代疗法和气管切除术.
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