在患有心肺疾病的患者中,手术肋骨固定改善了结果
Jennie S Kim1, Chih Ying Chien1,2, Meghan R Lewis1
1Trauma, Emergency Surgery and Surgical Critical Care, LA General Medical Center, 2051 Marengo St., IPT C5L100, Los Angeles, CA, 90033, USA.
概括
肋骨固定 (RF) 改善了心肺疾病 (CPD) 的患者的存活率. 尽管并发症增加,但RF在患有慢性慢性病的高风险患者中并非禁忌.
科学领域:
- 创伤外科 手术 创伤外科
- 胸部外科手术 胸部外科手术
- 关键护理医学 关键护理医学
背景情况:
- 肋骨固定 (RF) 对于胸部是有争议的,指导方针建议它只适用于特定的患者.
- 患有心肺疾病 (CPD) 的患者经常被排除在外手术考虑中,因为他们认为风险很高.
- 这项研究调查了高风险慢性肺病患者的射频疗效.
研究的目的:
- 评价肋骨固定 (RF) 对隔离胸和心肺疾病 (CPD) 的成年患者住院死亡率和并发症的影响.
- 为了确定RF在传统上被认为是非手术候选人的高风险CPD患者中是否提供生存益处.
主要方法:
- 从2016-2018年创伤质量改进计划数据库中确定了患有隔离胸部和慢性心脏病的成年患者.
- 排除标准包括医院转移,在72小时内死亡,穿透创伤,大动脉损伤或癌症.
- 倾向性得分匹配 (1:1) 用于比较RF (n=272) 与非手术管理 (NOM) (n=272) 患者.
主要成果:
- 射频与医院死亡率显著降低 (1.8%与5.5%,p=0.023).
- 射频患者的静脉血栓栓塞事件 (5.1%对1.85%),长时间通风 (28.4%对15.1%) 和气管切除 (15.4%对6.6%) 的比率较高.
- 多变量分析证实RF独立降低死亡率 (OR 0.165),而年龄>85岁和VAP增加死亡率.
结论:
- 肋骨固定在患有心肺疾病的高风险患者中显示出生存益处.
- 患者选择RF应该是个性化的,并且先前存在的CPD不应该是绝对的禁忌.
- 射频可以是一个可行的选择选择选择的CPD患者的胸部,挑战传统的外科排除标准.
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