手术治疗死性肠球炎患者30天死亡的危险因素:多中心回顾性队列研究
Adinda G H Pijpers1,2,3, Ceren Imren4, Otis C van Varsseveld5
1Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
概括
男性性别,较低的出生体重,门静脉气体,心血管支持和诊断和手术之间的短时间是导致早产婴儿死亡的关键手术前风险因素,包括NEC总量 (NEC-T).
科学领域:
- 新生儿科学 新生儿科学
- 儿科手术 儿科手术
- 胃肠病学 胃肠病学
背景情况:
- 死性肠球炎 (NEC) 是非常早产婴儿死亡的关键原因.
- 最广泛的形式NEC总数 (NEC-T) 在预测和管理方面提出了重大挑战.
- 准确的手术前风险评估对于在外科NEC病例中进行知情决策和咨询至关重要.
研究的目的:
- 确定与为NEC进行手术的早产婴儿30天死亡率相关的手术前风险因素.
- 在这个脆弱人群中确定NEC总数 (NEC-T) 的预测因子.
- 分析死亡风险因素,特别是在没有NEC-T的患者中.
主要方法:
- 多中心回顾性队列研究,包括为NEC (2008-2022) 手术治疗的早产婴儿 (<35周).
- NEC-T定义为广泛的小肠亡,需要进行开放式闭合式手术,无需治疗干预.
- 用多变量逻辑回归分析来评估手术前死亡率和NEC-T的风险因素.
主要成果:
- 总体30天死亡率为34.2%,其中NEC-T占病例的18.7%.
- 显著的死亡风险因素包括男性性别,低出生体重,门静脉气体 (PVG),手术前需要心血管支持,以及诊断到手术的时间缩短.
- 在NEC-T中发现了类似的风险因素;心血管支持和较短的诊断至手术间隔也预测了非NEC-T病例的死亡率.
结论:
- 男性性别,较低的出生体重,PVG,手术前心血管支持,以及NEC诊断和手术之间的短时间是死亡率和NEC-T的重要手术前风险因素.
- 这些已识别的因素可以帮助改善手术前风险分层和患者咨询.
- 进一步的研究可能将重点放在缓解这些已识别的风险的干预措施上.
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