与内血管干预相比,急性中肠性缺血的开放再血管化与增加的发病率和死亡率有关
Andrew S Warren1, Blake Murphy2, Nallely Saldana-Ruiz2
1Division of Vascular Surgery, University of Washington, Seattle, WA; Pacific Northwest University of Health Sciences, Yakima, WA.
Annals of vascular surgery
|November 23, 2024
概括
与开放式手术相比,急性介质性缺血症 (AMI) 的内血管干预显示了较低的术后发病率和死亡率. 肠切除的必要性并不排除对AMI的内血管治疗.
科学领域:
- 血管外科 血管外科
- 干预心脏病学 干预心脏病学
- 胃肠病学 胃肠病学
背景情况:
- 由于需要进行肠切除,开放的外科手术方法传统上主导了急性介肠缺血症 (AMI) 治疗.
- 血管内治疗越来越多地用于AMI,但对结果的比较数据仍然有限.
研究的目的:
- 为了比较急性介质缺血症 (AMI) 的开放式和内血管干预的结果.
- 评估干预类型对外科手术期间发病率和死亡率的影响,同时考虑肠切除的必要性.
主要方法:
- 从国家外科质量改进计划 (NSQIP) 数据库中对1172名在2011年至2022年期间接受治疗的AMI患者进行了回顾性分析.
- 使用CPT代码确定了干预类型 (开放式和内血管式).
- 进行了多变量分析,以调整患者人口统计学,并发病症和肠切除必要性的关键因素.
主要成果:
- 接受内血管修复的患者吸烟率更高,EGFR降低,需要肠切除的可能性更高.
- 开放式修复与更长的住院时间 (10天而不是7天) 有关.
- 在对肠切除和并发症进行调整后,开放式手术与显著更高的30天死亡率 (OR 1.96) 和呼吸机断奶失败 (OR 1.56) 相关联,以及延长住院时间 (3.7天以上).
结论:
- 与内血管干预相比,AMI的开放性再血管化与外科手术期间的发病率和死亡率的增加有关,即使考虑到疾病严重程度和并发症.
- 肠切除的必要性不应成为考虑在AMI患者内血管治疗的禁忌.
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