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急性手术与创伤性急性腹腔内血瘤的保守治疗
Thomas A Van Essen1,2,3,4, John K Yue3,4, Jason Barber5
1University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center & Haga, Leiden-The Hague, the Netherlands.
JAMA network open
|October 3, 2025
概括
针对急性腹腔内血瘤 (ASDH) 和创伤性脑损伤 (TBI) 的手术显示了与保守治疗相似的结果. 中心对手术的偏好并没有改善结果,这表明当结果不确定时,可以考虑保守的护理.
科学领域:
- 神经外科 神经外科
- 创伤护理 创伤护理
- 临床有效性研究研究 临床有效性研究
背景情况:
- 在创伤性脑损伤 (TBI) 后,急性腹腔内血瘤 (ASDH) 的最佳治疗策略尚不清楚.
- 将手术疏散与保守管理进行比较对于患者的治疗结果至关重要.
研究的目的:
- 为了比较急性手术ASDH疏散与初始保守治疗的有效性.
- 分析中心特定治疗偏好对患者结果的影响.
主要方法:
- 一项前性观察性研究,涉及18个美国一级创伤中心.
- 包括CT扫描检测到的非透性TBI和ASDH患者.
- 6个月后的功能性结果使用格拉斯哥结果尺度-扩展进行评估.
主要成果:
- 在711名ASDH患者中,有21%接受了急性手术,79%接受了保守治疗.
- 在各中心观察到急性手术率 (0% - 86%) 的显著变化.
- 中心对手术的偏好与改善的功能结果无关 (OR,1.05).
结论:
- 在偏爱手术疏散的中心和偏爱保守治疗的中心之间观察到类似的患者结果.
- 对于ASDH管理的中心特定治疗偏好没有影响患者的结果.
- 在神经外科医生面临临临床平衡时,保守治疗可能是ASDH患者的可行选择.
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