癌症手术患者的术中出血性休克,Shock

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癌症手术患者的术中出血性休克
Shock ( IF 2.7 ) Pub Date : 2020-03-19 , DOI: 10.1097/shk.0000000000001537
Annabelle Hamon , Djamel Mokart , Camille Pouliquen , Jean Manuel de Guibert , Sylvie Cambon , Lam Nguyen Duong , Eric Lambaudie , Antoine Sannini , Laurent Chow-Chine , Magali Bisbal , Jacques Ewald , Olivier Turrini , Marion Faucher

背景出血性休克的管理已被国际指南很好地编纂。这些指南主要基于创伤患者。我们旨在评估与主要肿瘤手术期间术中失血性休克后 30 天死亡率和长期生存率相关的因素。方法这项回顾性研究于 2013 年 1 月至 2018 年 2 月在癌症转诊中心进行。所有在手术室接受与术中失血性休克相关的预定或紧急肿瘤手术的成年癌症患者都包括在内。结果本研究共纳入了 84 名患者。30 天死亡率为 26%（n = 22），从入住 ICU 开始的平均随访时间为 20 个月（95% CI，15-25 个月），39 名（46%）患者在此期间死亡. 使用逻辑回归进行多变量分析，与 30 天死亡率独立相关的因素是 SAPS II 评分（优势比 (OR) =1.056，95% 置信区间 (CI) =1.010-1.1041）、delta SOFA（第 3 天 SOFA 评分 -第 1 天的 SOFA 评分）（OR= 1.780，95%CI 1.184-2.677）和 ISTH-DIC 评分（OR = 2.705，95%CI 1.108-6.606）。使用 Cox 多变量分析，与长期死亡率相关的因素是 delta SOFA（危险比 (HR) =1.558，95%CI 1.298-1.870）、ISTH-DIC 评分（HR = 1.381、95%CI 1.049-1.817）、肝脏功能障碍 (HR = 7.653, 95%CI 2.031-28.842) 和 Charlson 合并症指数 (HR = 1.330, 95%CI 1.041-1.699)。结论 ICU入院前三天器官功能障碍的恶化以及术中凝血障碍（ISTH-DIC评分增加）与短期和长期死亡率独立相关。合并症（查尔森合并症指数）和术后肝功能障碍与长期死亡率独立相关。应评估围手术期早期的集束化策略，以提高患者在这种特定情况下的生存率。

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Intraoperative Hemorrhagic Shock in Cancer Surgical Patients

BACKGROUND Management of hemorrhagic shock is well codified by international guidelines. These guidelines are predominantly based on trauma patients. We aimed to evaluate factors associated with 30-day mortality and long-term survival after intraoperative hemorrhagic shock during major oncological surgery. METHODS This retrospective study was conducted in a cancer referral center from January 2013 to February 2018. All adult cancer patients admitted in the operative room for scheduled or emergency oncological surgery associated with an intraoperative hemorrhagic shock were included. RESULTS Eighty-four patients were included in this study. The 30-day mortality rate was 26% (n = 22), the mean follow-up from the time of ICU admission was 20 months (95% CI, 15-25 months), 39(46%) patients died during this period. Using logistic regression for multivariate analysis, factors independently associated with 30-day mortality were SAPS II score (Odds Ratio (OR) =1.056, 95% Confident Interval (CI) =1.010-1.1041), delta SOFA (SOFA score at day 3 - SOFA score at day 1) (OR= 1.780, 95%CI 1.184-2.677) and ISTH-DIC score (OR = 2.705, 95%CI 1.108-6.606). Using Cox multivariate analysis, factors associated with long-term mortality were delta SOFA (Hazard Ratio (HR) =1.558, 95%CI 1.298-1.870), ISTH-DIC score (HR = 1.381, 95%CI 1.049-1.817), hepatic dysfunction (HR = 7.653, 95%CI 2.031-28.842) and Charlson co-morbidity index (HR = 1.330, 95%CI 1.041-1.699). CONCLUSION The worsening of organ dysfunctions during the first three days of ICU admission as well as intraoperative coagulation disturbances (increased ISTH-DIC score) are independently associated with short and long-term mortality. Co-morbidities (Charlson co-morbidity index) and post-operative hepatic dysfunction were independently associated with long term mortality. Early perioperative bundle strategies should be evaluated in order to improve patient's survival in this specific situation.

更新日期：2020-03-19

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