下肢急性隔间综合征的切术后并发症:一个系统的审查和比例的元分析
Garikai Kungwengwe1, Douglas Donnachie2, Kinseng Tong3
1Imperial College London, London, UK.
概括
在六小时内进行早期带切除和隔间内压力监测 (ICPM) 显著降低下肢急性隔间综合征 (ACS) 中的截肢风险. 虽然血管损害增加了截肢的几率,但其对死亡率的影响尚不清楚.
科学领域:
- 整形外科手术 整形外科手术
- 创伤外科 手术 创伤外科
- 血管外科 血管外科
背景情况:
- 下肢急性隔间综合征 (ACS) 是一种需要及时诊断和干预的外科紧急情况.
- 筋切割术是ACS的最终治疗方法,但筋切割术后的结果,包括截肢和死亡率,各不相同.
- 影响这些结果的风险因素需要进一步阐明,以优化患者管理.
研究的目的:
- 更新关于下肢 ACS. 下肢 ACS. 下肢切割术后结果的证据.
- 量化截肢和死亡率的综合流行率.
- 评估关键风险因素对这些结果的影响.
主要方法:
- 从研究开始到2024年7月,对研究进行符合PRISMA的系统审查和元分析.
- 使用Joanna Briggs研究所,国家卫生研究院和GRADE方法评估的偏见风险和证据确定性.
- 使用弗里曼-图基变换计算的聚合患病率;对几率比率的后勤回归 (随机效应模型).
主要成果:
- 包括11项涉及2504名患者的研究.
- 总的死亡率:7.7% (95% CI,4.6-11.5%);截肢的发生率:10.5% (95% CI,7.8-13.5%).
- 早期断层切除 (<6小时) 和内部压力监测 (ICPM) 显著降低了截肢几率;血管妥协增加了截肢几率,但不增加死亡率.
结论:
- 早期断层切除和ICPM可以减轻下肢ACS截肢的风险.
- 血管损伤是截肢的重要危险因素,但其与死亡率的关联不确定.
- 及时的外科干预和ICPM至关重要;需要进一步的高质量研究来证实研究结果.
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