鼻腔管与尿道支架用于阻塞 septical calculi:全国性的倾向性得分匹配分析
Rachel Wong1, Jennifer Ziegler2, Dhiraj S Bal3
1Department of Surgery, Section of Urology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
概括
阻塞性尿路病的败血症需要紧急减压. 这项研究发现,在匹配后,穿皮瘤管 (PCN) 和逆行尿道支架 (RUS) 之间的死亡率没有显著差异,这表明当地实践应该指导治疗.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 关键护理医学 关键护理医学
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 阻塞性尿路病变后的败血症是一种危急的病症,需要迅速减压尿路.
- 穿皮瘤管 (PCN) 和逆行尿道支架 (RUS) 是常见的减压方法,但它们对死亡率的比较影响尚不清楚.
研究的目的:
- 调查选择减压方法 (PCN与RUS) 与败血症和阻塞性泌尿病患者住院死亡率之间的关联.
- 分析二次结果,包括停留时间,机械通风和透析需求.
主要方法:
- 从2006-2014年全国住院患者样本 (NIS) 中对34,009名患者进行了回顾性队列分析.
- 包括患有败血症和受PCN或RUS治疗的阻塞性尿路病的患者.
- 使用多变量逻辑回归和倾向得分匹配来评估PCN与RUS对死亡率的影响.
主要成果:
- 与RUS组 (2.8%) 相比,PCN组 (5.3%) 的未调整死亡率更高.
- 多变量分析表明,RUS的死亡率较低 (OR 0.72;95% CI 0.63-0.83).
- 然而,在倾向分数匹配后,PCN (4.0%) 和RUS (3.4%) 组之间没有观察到死亡率的显著差异 (p=0.19).
结论:
- 在PCN和RUS之间,在通过倾向匹配计算患者特征时,对于阻塞性尿路病变的二次性败血症,在住院死亡率上没有显著差异.
- 治疗选择应基于既定的当地做法和患者特定因素.
- 需要进一步进行高质量的前性随机试验,以确定最佳的减压策略.
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