营养不良与慢性四肢威胁性缺血的死亡率和截肢结果之间的关联:系统性审查
Lindsey E Scierka1, Jacob Cleman1, Aaron E Brice1
1Vascular Medicine Outcomes Program, Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA.
概括
营养不良显著增加了慢性肢体威胁性缺血症 (CLTI) 患者死亡和截肢的风险. 早期识别和干预对于改善CLTI患者的治疗结果至关重要.
科学领域:
- 血管外科 血管外科
- 营养科学 营养科学
- 临床医学 临床医学
背景情况:
- 营养状况显著影响慢性四肢威胁性缺血症 (CLTI) 的病理生理学和结果.
- 营养不良是CLTI患者潜在的可修改风险因素.
- 现有研究表明,在CLTI中定义和测量营养状况方面存在差异.
研究的目的:
- 系统地审查营养不良和CLTI患者的结果之间的关联.
- 综合证据,说明不同的营养状况测量与死亡率和截肢风险的关系.
- 确定目前关于CLTI营养状况的研究中的差距.
主要方法:
- 在9个主要数据库中进行系统的文献搜索,截至2023年5月.
- 包括1982年以后发表的CLTI患者的随机对照试验,队列研究和病例控制研究.
- 独立的选,数据提取和质量评估由两个审查员进行,第三个审查员解决冲突.
主要成果:
- 包括49项涉及6,818个引用的观察性研究,大多数患者接受了重血管化.
- 单维 (如低白蛋白,BMI) 和多维 (如查工具) 的营养不良指标都与死亡和截肢风险的增加有关.
- 使用多维营养查工具,效果大小更大,但证据质量差,确定性非常低.
结论:
- 营养不良始终与CLTI患者的死亡和截肢风险较高有关,无论评估方法如何.
- 需要进一步的研究来完善对CLTI营养状况框架的理解.
- 对于专门针对CLTI种群的营养查工具的验证至关重要.
相关概念视频
01:23Atherosclerosis IV: Nursing Management
Nursing management for a patient with arteriosclerosis involves a comprehensive approach focusing on lifestyle modification, disease monitoring, education, and symptomatic care. Here is an overview of effective nursing strategies:Assessment and Monitoring: Initial and ongoing assessments are crucial. Nurses must document the patient's medical history, including any hypertension, diabetes, hyperlipidemia, and other cardiovascular diseases. Assessments also cover family history and lifestyle...
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
01:27Peripheral Artery Disease III: Interprofessional Care
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
01:26Peripheral Artery Disease IV: Nursing Management
The nursing management of a patient with peripheral artery disease (PAD) begins with a thorough assessment of the patient’s health history and clinical manifestations.AssessmentHealth History: Evaluate the patient’s history of hypertension, hyperlipidemia, family history of cardiovascular issues, and lifestyle factors such as dietary patterns, smoking, and physical activity.Physical Examination:Assess the affected extremity for decreased or absent peripheral pulses, temperature changes,...
01:23Peripheral Artery Disease V: Postoperative Nursing Management
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
01:31Diabetic Foot Ulcer
Definition A diabetic foot ulcer (DFU) is a chronic, non-healing wound that develops in individuals with diabetes. It typically occurs on pressure-bearing areas such as the heel, metatarsal heads, or hallux, and carries a high risk of infection and amputation.Pathophysiology • The development of DFUs can be explained by four interconnected mechanisms: neuropathy, ischemia, infection, and impaired wound healing. • Neuropathy is the most common factor. Sensory neuropathy reduces pain perception,...