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JACC:经导管主动脉瓣置换术后早期放电与标准放电的比较

2018-09-04 xiangting MedSci原创

在出院至30天死亡率或出院后PPI需求方面,无并发症TAVR后的ED是安全的。

这项研究旨在评估早期放电(ED)vs标准放电(SD)经导管主动脉瓣置换(TAVR)患者的临床结局。

目前已经开发出了针对TAVR手术不同方面的极简主义方法,例如局部麻醉或镇静、术中成像、血管通路、术后监测和护理以及出院计划。与标准方法相比,将这些极简主义方法纳入常规临床实践旨在减少住院时间和医疗成本利用,而不会对预后有不利影响。

作者对MEDLINE和EMBASE进行检索,以查找在TAVR患者中分析ED(≤3天)vs. SD的研究。使用随机效应meta分析评估ED vs.SD对出院后30天死亡率、30天再入院率以及出院后永久性起搏器植入(PPI)需求的影响。

8项研究符合纳入标准,共包括1,775名参与者(ED,n=642)。平均年龄82.4岁,STS评分6.7。评估出院至30天的死亡率(比值比[OR]:0.65; 95%置信区间[CI]:0.23至1.82; I2=0%)、出院至30天新PPI的meta分析(OR:1.61;95%CI:0.19至13.71;I2=40%)显示ED与SD策略没有显著差异。值得注意的是,与SD患者相比,ED患者在ED后再入院的可能性较小(OR:0.63;95%CI:0.41至0.98; p=0.04,I2=0%)。

在出院至30天死亡率或出院后PPI需求方面,无并发症TAVR后的ED是安全的。此外,ED患者的再入院率较低。这些数据支持在选定TAVR患者中针对ED途径手术的安全性。应制定机构协议优化出院过程,其中应包括来自多学科心脏团队不同成员的意见,从而改善医疗资源的利用。

原始出处:
Rafail A. Kotronias,et al. Early Versus Standard Discharge After Transcatheter Aortic Valve Replacement.A Systematic Review and Meta-Analysis. JACC:Cardiovascular Interventions. September 2018.

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    2019-01-08 yxch48
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    2018-12-17 hbwxf
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  5. 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  6. 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  7. 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2018, time=2018-09-06, status=1, ipAttribution=)]
    2018-09-06 lsj631
  8. 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