在感染SARS-CoV-2-A患者的气管切除术后术后出血的关系中,低分子量肝素剂量描述性研究
David Victorin1,2, Henrik Bergquist3,4, Louise Hafsten3
1Department of Otorhinolaryngology Region Västra Götaland, Södra Älvsborg Hospital Borås Sweden.
Laryngoscope investigative otolaryngology
|April 3, 2025
概括
推迟或减少低分子量肝素 (LMWH) 并没有降低接受气管切除术的SARS-CoV-2患者的出血风险. 老年被确定为这些患者手术后出血的重要危险因素.
科学领域:
- 医学 医学 医学 医学 医学
- 外科手术 手术手术
- 关键护理医学 关键护理医学
背景情况:
- 患有严重SARS-CoV-2的患者通常需要密集护理和机械通风.
- 气管切除术是重症SARS-CoV-2患者的常见手术,以促进从机械通风中断奶.
- 在这些患者中使用低分子量肝素 (LMWH) 引发了对潜在的出血并发症的担忧,特别是在像气管切割这样的手术过程中.
研究的目的:
- 调查手术气管切除术当天修改LMWH的时间或剂量是否会影响SARS-CoV-2患者手术后出血的发生率.
- 在这个患者群体中确定与术后出血相关的危险因素.
主要方法:
- 对101名在重症监护病房进行了外科气管切除的SARS-CoV-2患者进行了回顾性分析.
- 收集的数据包括患者的并发症,LMWH剂量和与手术相比的施用时间.
- 在72小时内记录和分析了术后出血事件 (胃或呼吸道).
主要成果:
- 在没有改变,推迟或减少LMWH剂量的患者之间,在出血发生率上没有发现显著差异.
- 降低LMWH剂量并没有显著降低出血风险 (OR 1.29).
- 与没有变化相比,推迟LMWH并没有显著降低出血风险 (OR 1.03).
- 年龄的增加与手术后出血风险的增加显著相关 (OR为每十年1.64).
- 没有报告与气管切割相关的致命出血事件.
结论:
- 在SARS-CoV-2患者的气管切除术当天降低或推迟LMWH剂量与术后出血风险降低无关.
- 年龄的增加是进行气管切除术的患者手术后出血的重要危险因素.
- 需要仔细考虑与外科手术相关的抗凝管理,年龄是风险评估的关键因素.
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