糖尿病患者膝下截肢后死亡的危险因素
Itay Ron1, Shay Zvi Cherevatsky2, David Shaked Zari1
1Orthopedic Department, Rambam Medical Center, Haifa, Israel.
概括
接受膝下截肢 (BKA) 的糖尿病患者面临高死亡率. 术前因素,如慢性病 (CKD),低专蛋白和高白细胞 (WBC) 计数,预测死亡风险增加.
科学领域:
- 血管外科 血管外科
- 糖尿病学 糖尿病学
- 公共卫生 公共卫生
背景情况:
- 糖尿病足往往需要主要的下肢截肢,包括膝下截肢 (BKA),当四肢救援失败时.
- 尽管是源控制措施,但糖尿病患者的BKA与高的术后死亡率有关.
研究的目的:
- 在糖尿病患者中确定手术前的人口统计学,临床和实验室因素,与糖尿病患者首次膝下截肢 (BKA) 后的死亡率相关.
- 在这个高风险人群中评估BKA后的短期和中期全因死亡率.
主要方法:
- 追溯队列研究分析了1487名糖尿病患者接受初级BKA.
- 在手术后的30,90,180,365天评估了死亡率.
- 多变量逻辑回归确定了死亡率的独立预测因素.
主要成果:
- 不幸存者年龄较大,查尔森并发症指数得分较高,血清白蛋白水平较低.
- 死亡率增加的独立预测因素包括慢性病 (CKD),白蛋白<2.95 g/dL,高白细胞计数 (>13.805 × 109/L),查尔森并发症指数>5.5,以及手术后口服与输液抗生素.
结论:
- 在糖尿病患者中,手术前的并发症 (CKD,高并发症负担) 和实验室标志物 (低白蛋白血症,升高的WBC) 显著增加了BKA后的死亡风险.
- 综合性术前评估和有针对性的术后策略对于改善这一脆弱患者群体的治疗结果至关重要.
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