在大动脉解剖后,对于中腹腔缺血的拉皮切除术何时是徒劳的?
Nicholas J Goel1, Joshua Anil1, John J Kelly1
1Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
The Annals of thoracic surgery
|August 24, 2024
概括
拉巴切除术用于大动脉解剖与中肠缺血提供生存益处,但严重的乳酸症表明徒劳. 手术前的乳酸盐和pH值预测结果,指导手术决策以改善患者的生存率.
科学领域:
- 心血管外科心血管外科
- 胃肠病学 胃肠病学
- 关键护理医学 关键护理医学
背景情况:
- 大动脉解剖后的中腔缺血可能导致败血症和死亡.
- 紧急腹腔切除术对于生存至关重要,但在严重的情况下可能是徒劳的.
- 这项研究研究了腹腔切除术在患有大动脉解剖和中肠缺血症的患者中的作用.
研究的目的:
- 为了确定当腹腔切除术提供有意义的存活在患有大动脉剖析和中腔缺血的患者.
- 在这个患者群体中确定腹腔切除术后生存的预测因素.
主要方法:
- 对145名患有大动脉剖析和中肠缺血症的患者进行了回顾性审查 (2006-2022年).
- 对29名经过腹腔切除术的患者的临床特征和结果的分析.
- 作为生存预测指标的血清乳酸和动脉pH值的统计分析.
主要成果:
- 经过腹腔切除术的45%的患者存活到出院.
- 血清乳酸>8 mmol/L和pH<7.30是高度预测死亡率 (OR分别为16.5和14.4).
- 患有严重乳酸血症和酸症的患者的生存率为9%,而没有乳酸血症的患者为90%.
结论:
- 乳酸症的严重程度有效地识别出腹腔切除术是徒劳的患者在大动脉解剖后与介质性缺血.
- 在手术前的乳酸盐和pH值对于指导手术决策至关重要.
- 这些数据可以帮助优化腹腔切除术患者的选择,改善结果.
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