在急性甲型大动脉剖析中器官特异性输血:流行病学上对发病率的元分析
Ashwini Chandiramani1, Mohammed Al-Tawil2, Assem Elleithy3
1Department of Cardiac Surgery, St Thomas' Hospital, London, UK.
BJS open
|January 10, 2025
概括
急性A型大动脉剖析与器官输血显著增加死亡率. 中腔,冠状动脉和大脑缺血风险最高,需要仔细的手术规划.
科学领域:
- 心血管外科心血管外科
- 血管外科 血管外科
- 胸部外科手术 胸部外科手术
背景情况:
- 急性A型大动脉解剖 (aTAAD) 是一种高死亡率的关键外科紧急情况.
- 恶性 perfusion 综合征使 aTAAD 复杂化,大大增加了术后死亡率.
- 在aTAAD中,器官失 perfusion 影响各种血管床,包括冠状动脉,大脑,内脏,脏和脊柱动脉.
研究的目的:
- 在 aTAAD 中系统地审查和元分析器官特异性输血病的流行病学.
- 评估不同类型的阻 perfusion 对 aTAAD 患者的生存结果的影响.
主要方法:
- 系统审查和对2024年9月之前发表的研究进行元分析.
- 在PubMed,MEDLINE和Embase数据库中搜索了关于aTAAD和器官输血的数据.
- 提取了患者的特征,器官特异性输血失效的发生率和住院死亡率.
- 使用修改后的美国国立卫生研究院质量评估工具进行单臂观察性研究.
主要成果:
- 分析了40项涉及35,361名患者的研究.
- 周围四肢阻塞的综合发病率最高 (12%),其次是 iliofemoral (11%).
- 脊椎阻塞是最不常见的 (1%).
- 综合死亡率在18%至36%之间,中腔 (36%),冠状动脉 (33%) 和大脑 (28%) 输血的死亡率最高.
结论:
- 在 aTAAD 之后的医院存活率受阻 perfusion 的存在和类型的影响.
- 中腔,冠状动脉和大脑输血与最高的住院死亡率有关.
- 在 aTAAD 中,特定器官的阻 perfusion 综合征是评估外科手术风险和手术规划的关键因素.
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