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手术前数据无法准确预测哪些接受大肝脏手术的患者会出现术后凝血障碍:一家单一医院的回顾性队列研究
Gabriel E Vazquez1, Franklin Dexter2,3, Ravina S Vasanwala1
1Department of Anesthesia, University of Iowa, Iowa City, IA, USA.
概括
手术后凝血障碍在肝脏手术后很常见,在25%的患者中发生在72小时内. 标准的手术前评估无法预测这些事件,需要仔细考虑外周止痛.
科学领域:
- 麻醉学和外科手术期间的医学.
- 肝胆道手术 肝胆道手术
- 凝血科学 凝血科学
背景情况:
- 外周止痛药在肝胆外科手术中是有效的,但肝切除后的凝血障碍构成风险.
- 脊柱外周血瘤是潜在出血风险的患者外周止痛的关注点.
研究的目的:
- 开发术后凝血障碍的预测模型,用于经过肝切除的患者,有资格接受外周止痛.
- 确定预测国际正常化比率 (INR) >1.5 的因素,部分血栓形成时间 (PTT) >40秒,或血小板数 <100,000/μL.
主要方法:
- 对684名肝切除患者 (2011-2023) 的回顾性队列研究.
- 对患者特征,手术参数和手术前后凝血实验室的分析.
- 利用分类树和逐步逆向物流回归用于预测建模.
主要成果:
- 在72小时内发生25%的术后凝血障碍,主要是血小板缺血 (20%).
- 较大的肝切除体积与凝血障碍相关 (AUC 0.61).
- 在性别,ASA状态,BMI,体重,年龄,化疗,手术持续时间或年龄方面没有发现显著的预测值.
结论:
- 肝脏手术后经常出现凝血障碍.
- 术前数据不足以预测接受外周止痛治疗的患者的术后凝血问题.
- 手术后凝血病的风险在72小时内超过5%,影响了增强的恢复方案和外围导管切除时间.
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