在肝硬化患者中预测和预防术后出血
Alix Riescher-Tuczkiewicz1, Pierre-Emmanuel Rautou1,2
1Paris City University, Inserm, Inflammatory Research Center, UMR 1149, Paris, France.
Clinical and molecular hepatology
|February 18, 2025
概括
在肝硬化患者中预测和预防术后出血是至关重要的. 建议采用综合方法,考虑患者因素,手术风险和血小板计数,因为预防性血静修复缺乏强有力的证据.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 胃肠病学 胃肠病学
- 干预医学是干预的医学.
背景情况:
- 肝硬化患者的手术后出血虽然不常见,但患病率和死亡率很高.
- 预测和预防这些出血对于患者的结果至关重要.
- 已确定的预测因素包括高风险手术,严重肝硬化和高BMI,而其他如贫血和AKI的预后价值不确定.
研究的目的:
- 审查目前关于预测和预防肝硬化患者手术后出血的知识.
- 要突出在这个人群中管理抗血栓药物的挑战.
- 评估各种诊断和预防措施的有用性.
主要方法:
- 审查已确定的和潜在的术后出血预测因素.
- 评估诊断工具,如血小板计数,血栓生成试验和粘弹性测试.
- 对周围手术抗血栓药物管理策略的分析.
- 评估技术程序修改和预防性干预措施.
主要成果:
- 血小板计数,血小板生成和粘性弹性测试可能是有用的.
- 谨慎的抗血栓药物管理是关键,尽管缺乏对肝硬化患者的具体数据.
- 超声指导,横接入和操作人员的专业知识可以降低出血风险.
- 血小板输血和血小板蛋白受体激动剂的疗效不确定;不建议使用FFP,纤维素和胺酸.
结论:
- 预测术后出血需要进行整体评估,包括患者特征,手术风险和血小板计数.
- 有有限的证据支持预防性血静纠正.
- 进一步的专业研究对于优化肝硬化患者的出血预防至关重要.
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