在老年关节骨折患者手术前心声图如何影响护理? 一个匹配的队列研究
Laura Y Lu1,2, Katherine Rowe3, Matthew Johnson3
1Brigham and Women's Hospital, 60 Fenwood Road 2nd Floor Hale Building for Transformative Medicine, Boston, USA.
Archives of orthopaedic and trauma surgery
|June 14, 2025
概括
在老年关节骨折患者手术前的胸前心电回声 (TTE) 往往会延迟手术并增加90天的死亡率,即使有指示. 快速的手术前评估对于优化患者的治疗结果至关重要.
科学领域:
- 老年医学 老年医学
- 心脏病学 心脏病学
- 创伤外科 手术 创伤外科
背景情况:
- 部骨折在老年人中很常见,需要及时进行手术.
- 在关节骨折患者的早期干预与医疗优化之间取得平衡是具有挑战性的.
- 手术前的胸前心电回声 (TTE) 可能会延迟关节骨折手术,但其指示需要澄清.
研究的目的:
- 确定老年关节骨折患者中指示的手术前TTE的比例.
- 评估遵守美国心脏病学会/美国心脏协会 (ACC/AHA) 关于TTE的指导方针.
- 评估TTE在患有肺高血压,昏迷或中风的患者中的使用.
主要方法:
- 对113名老年关节骨折患者进行了回顾性病例对照研究,这些患者接受了手术前的TTE.
- 匹配了113名没有手术前TTE的关节骨折患者的对照组.
- 主要结局:指示的TTE的比例;次要结局:外科手术期间的管理变化,手术的时间,住院时间和死亡率.
主要成果:
- 根据指导方针,71.7%的手术前TTEs是指定的.
- 使用TTE与更长的手术时间 (44.8小时 vs 24.2小时) 和停留时间 (7天 vs 5天) 的增加有关.
- TTE组显示90天死亡率更高 (OR4.4),但2年死亡率没有差异.
结论:
- 在老年关节骨折患者的手术前TTE与手术延迟和短期死亡率增加有关.
- 尽管许多TTE是指定的,但它们影响了外科手术期间的管理和结果.
- 强调需要对老年骨折患者进行高效的手术前评估.
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