非闭塞性肠系膜缺血术后辅助血管扩张剂治疗与住院死亡率之间的关系:一项全国性观察研究。

IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Journal of Nippon Medical School Pub Date : 2024-01-01 DOI:10.1272/jnms.JNMS.2024_91-310
Toru Takiguchi, Mikio Nakajima, Hiroyuki Ohbe, Yusuke Sasabuchi, Takashi Tagami, Richard H Kaszynski, Hiroki Matsui, Kiyohide Fushimi, Shiei Kim, Shoji Yokobori, Hideo Yasunaga
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引用次数: 0

摘要

背景:尽管一些临床指南建议对非闭塞性肠系膜缺血(NOMI)使用血管扩张剂治疗,并在怀疑肠坏死时立即进行手术,但这些建议都是基于有限的证据:在这项全国范围的回顾性观察研究中,我们使用了 2010 年 7 月至 2018 年 3 月期间日本诊断程序组合住院患者数据库中的信息,以确定入院当天接受腹部手术的非闭塞性肠系膜缺血患者。我们比较了术后接受血管扩张剂治疗的患者(血管扩张剂组)和未接受治疗的患者(对照组)。血管扩张剂治疗的定义是在入院 2 天内通过静脉和/或动脉使用木蝴蝶碱和/或前列腺素 E1。主要结果为院内死亡率。次要结果包括入院后≥3 天内再次进行腹部手术的发生率和短肠综合征:我们确定了 928 名符合条件的患者(血管扩张剂组 149 人,对照组 779 人)。通过一对四倾向评分匹配,血管扩张剂组和对照组分别有 149 名和 596 名患者。两组患者的院内死亡率无明显差异(对照组 vs. 血管扩张剂组,27.5% vs. 30.9%;风险差异,3.4%;95% 置信区间,-4.9 至 11.6;P=0.42),腹部手术、入院后≥3 天的肠切除术和短肠综合征的发生率也无明显差异:结论:在接受手术治疗的NOMI患者中,术后使用血管扩张剂与降低院内死亡率或入院后≥3天进行额外腹部手术无明显关联。
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Association between Postoperative Adjuvant Vasodilator Therapy and In-Hospital Mortality for Non-Occlusive Mesenteric Ischemia: A Nationwide Observational Study.

Background: Although several clinical guidelines recommend vasodilator therapy for non-occlusive mesenteric ischemia (NOMI) and immediate surgery when bowel necrosis is suspected, these recommendations are based on limited evidence.

Methods: In this retrospective nationwide observational study, we used information from the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018 to identify patients with NOMI who underwent abdominal surgeries on the day of admission. We compared patients who received postoperative vasodilator therapy (vasodilator group) with those who did not (control group). Vasodilator therapy was defined as venous and/or arterial administration of papaverine and/or prostaglandin E1 within 2 days of admission. The primary outcome was in-hospital mortality. Secondary outcomes included the prevalence of additional abdominal surgery performed ≥3 days after admission and short bowel syndrome.

Results: We identified 928 eligible patients (149 in the vasodilator group and 779 in the control group). One-to-four propensity score matching yielded 149 and 596 patients for the vasodilator and control groups, respectively. There was no significant difference in in-hospital mortality between the groups (control vs. vasodilator, 27.5% vs. 30.9%; risk difference, 3.4%; 95% confidence interval, -4.9 to 11.6; p=0.42) and no significant difference in the prevalences of abdominal surgery, bowel resection ≥3 days after admission, and short bowel syndrome.

Conclusions: Postoperative vasodilator use was not significantly associated with a reduction in in-hospital mortality or additional abdominal surgery performed ≥3 days after admission in surgically treated NOMI patients.

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来源期刊
Journal of Nippon Medical School
Journal of Nippon Medical School MEDICINE, GENERAL & INTERNAL-
CiteScore
1.80
自引率
10.00%
发文量
118
期刊介绍: The international effort to understand, treat and control disease involve clinicians and researchers from many medical and biological science disciplines. The Journal of Nippon Medical School (JNMS) is the official journal of the Medical Association of Nippon Medical School and is dedicated to furthering international exchange of medical science experience and opinion. It provides an international forum for researchers in the fields of bascic and clinical medicine to introduce, discuss and exchange thier novel achievements in biomedical science and a platform for the worldwide dissemination and steering of biomedical knowledge for the benefit of human health and welfare. Properly reasoned discussions disciplined by appropriate references to existing bodies of knowledge or aimed at motivating the creation of such knowledge is the aim of the journal.
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