麻症和ASA状态在预测紧急腹腔切除术后死亡率上的协同效应:系统性审查和分析与回归
Ahmad Al-Sarireh1, Hashim Al-Sarireh2, Olivia Ambler3
1University of Cambridge, Cambridge, UK.
Updates in surgery
|January 17, 2025
概括
在紧急腹腔切除术后,肉类显著增加了30天死亡风险. 美国麻醉学会 (ASA) 的地位,特别是III-V等级,进一步提高了这种风险,表明对患者的结果有协同效应.
科学领域:
- 老年学是一门学科.
- 外科手术的结果
- 麻醉学 麻醉学
背景情况:
- 随着年龄增长而导致的骨肌肉质量丧失,萨尔科佩尼亚 (Sarcopenia) 越来越被认为是不良结果的预测因素.
- 美国麻醉学会 (ASA) 的身体状态分类系统是广泛使用的工具,用于评估患者的并发症和预测手术风险.
研究的目的:
- 调查萨尔科佩尼亚和ASA状态在紧急腹腔切除术后30天术后死亡率的独立和联合预测值.
- 确定ASA状态的关键值,这些值会加剧萨科佩尼和非萨科佩尼患者的死亡风险.
主要方法:
- 一个符合PRISMA的系统审查和七项研究的元分析,涉及2663名接受紧急腹腔切除术的患者.
- 使用元回归分析来评估ASA状态对30天死亡率的影响,在sarcopenic与非sarcopenic患者中.
- 偏差风险和证据确定性分别使用QUIPS工具和GRADE系统进行评估.
主要成果:
- 与非sarcopenic患者 (6.2%) 相比,sarcopenic患者的三十天死亡风险要高得多 (22.9%),赔率比率为4.452 (p=0.016).
- 在麻症患者中,ASA状态IV-V显著增加了死亡风险. 在非癌症患者中,ASA状态III和IV-V增加了死亡风险.
- 标出了萨尔科佩尼亚和ASA状态作为死亡率的独立预测因素,对整体风险产生协同作用.
结论:
- 萨科佩尼亚是紧急腹腔切除术后30天死亡率的重要独立预测因子.
- ASA状态,特别是更高的等级 (III-V),在接受紧急腹腔切除术的患者中,协同增加死亡风险,对于肉和非肉患者确定了特定的值.
- 这些发现凸显了评估肉症与ASA状态一起进行全面的手术前风险分层的重要性.
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