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对急性A型大动脉剖析与中腔输出不良流的管理进行系统审查
Changtian Wang1, Haiwei Wu1, Zhilong Xi1
1Department of Cardiovascular Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 210002 Nanjing, China.
Reviews in cardiovascular medicine
|July 30, 2024
概括
急性A型大动脉剖析与中枢膜输血是一种罕见的,高死亡率的并发症. 中枢大动脉修复和SMA再注血显示出更好的结果比内脏干预或医疗护理对这种情况.
科学领域:
- 心血管外科心血管外科
- 血管外科 血管外科
- 胃肠道手术 胃肠道手术
背景情况:
- 甲型急性大动脉解剖 (aTAAD) 带有中枢膜外注 (MMP) 具有重大管理挑战和糟糕的患者结果.
- 与MMP一起的aTAAD的最佳手术策略仍然存在争议,需要进一步调查.
研究的目的:
- 分析和比较不同一线治疗策略的有效性,急性A型大动脉解剖复杂的中腔混凝土.
- 在这种复杂的临床场景中,确定影响患者结果的因素.
主要方法:
- 在MEDLINE和EMBASE数据库中进行了全面的文献搜索,截至2021年12月31日.
- 来自19项符合条件的研究的数据,包括352名患有TAAD和MMP的患者,被提取并分析了管理策略,死亡率和并发症.
主要成果:
- 患有MMP的aTAAD的整体住院死亡率为43.5%,主要死亡原因是肠道缩和多器官衰竭.
- 中枢大动脉修复 (54.3%) 和上层中枢动脉 (SMA) 再注血 (34.3%) 与内脏干预 (72.7%) 或医疗护理 (93.1%) 相比,死亡率较低 (分别为40.3%和33.9%).
- 中央大动脉修复和SMA再注血作为一线治疗方法之间没有观察到死亡率的显著差异 (p=0.254).
结论:
- 中央大动脉修复和SMA再输与与MMP相比较少侵入性或医疗管理的 aTAAD 的改善结果有关.
- 鉴于临床表现的变化,建议针对MMP复杂的TAAD患者采取个性化的治疗方法.
- 临床决策中的潜在偏见在比较治疗策略时需要考虑.
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