前期心脏手术是大动脉手术患者的风险因素吗:系统性审查和元分析
Qianlei Lang1, Julin Zhang1, Jili Li2
1Department of Cardiovascular Surgery and Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Journal of cardiothoracic and vascular anesthesia
|July 24, 2025
概括
与初级大动脉手术 (PAS) 相比,重复大动脉切除术 (RAS) 的住院死亡率和术后风险更高. 然而,先前的心脏手术并不会减少大动脉手术的长期益处.
科学领域:
- 心血管外科心血管外科
- 胸部外科手术 胸部外科手术
- 大动脉外科手术
背景情况:
- 大动脉手术的发生率越来越高,需要复杂的重新手术.
- 重复切断大风口手术 (RAS) 与初级大风口手术 (PAS) 的结果尚未明确.
- 以前的心脏手术可能是大动脉干预的风险因素.
研究的目的:
- 为了比较一次性大动脉手术 (PAS) 和重复椎切除大动脉手术 (RAS) 之间的外科结果.
- 评估先前的心脏手术是否是大动脉手术结果的风险因素.
主要方法:
- 在PubMed,Embase和Web of Science的系统文献搜索.
- 对19项涉及31,631名参与者的研究进行了元分析.
- 主要结局:住院死亡率. 二次结果:重新探索出血,功能衰竭,深胸部伤口感染,神经事件,绕道时间和长期生存.
主要成果:
- 与PAS相比,RAS组的住院死亡率显著更高 (16.0%与9.3%相比) 和重新探索出血,功能衰竭和深部伤口感染的风险增加.
- 重复的骨切除术根部置换手术显示,死亡率特别高.
- 短期生存率有利于PAS,但长期生存率在各组之间趋同.
结论:
- 重复大动脉切除手术与显著更高的住院死亡率和术后并发症有关.
- 与RAS相关的风险在根置换手术中更为明显.
- 之前的心脏手术并不能否定大动脉手术的长期优势.
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