Cov txiaj ntsig ntawm Dexmedetomidine Ntawm Kev phais Rau Hom A Acute Aortic Dissection Outcome

Hom A mob aortic dissectionyog qhov xwm txheej ceev xwm txheej ceev txog txoj sia. Txawm hais tias muaj kev ua haujlwm hnyav thiab cov txheej txheem kev nce qib, kev tuag ntawm kev phais tseem muaj ntau. Raws li German Registry for Acute Aortic Dissection Type A (GERAADA), txij xyoo 2006 txog 2010, 2137 cov neeg mob tau raug phais kho mob rau hom mob Aortic dissection nrog tag nrho 30-hnub tuag ntawm 16.9%1. Lwm tsab ntawv ceeb toom los ntawm International Registry ntawmMob Aortic Dissection(IRAD) qhia tau hais tias, dhau sij hawm, txij li xyoo 1995 txog 2013, kev tuag ntawm cov neeg mob hauv tsev kho mob ntawm hom A aortic dissection poob qis los ntawm 31%, tab sis tseem siab li 22%.2. Hom A mob aortic dissection kuj tuaj nrog ntau yam teeb meem loj, suav nrog kev poob siab, tamponade, visceral ischemia, peripheral ischemia, thiab mob hlwb. Tsis tas li ntawd, cov teeb meem me xws li mob raum raug mob, delirium, atrial fibrillation, thiab ua pa tsis ua haujlwm kuj tshwm sim tom qab ua haujlwm.Cardiopulmonary bypass(CPB) ua rau mob thoob plaws hauv lub cev, ua rau lub cev tsis ua haujlwm3. Kev tshawb fawb kuj tau pom tias muaj cov txheej txheem inflammatory yog koom nrog hauv medial degeneration thiab nws koom nrog kev kho mob tshwm sim ntawm aortic dissection.4. 

NYEM QHOV NO TUAJ SAIB HNUB NYOOG CISTANCHE FOR KIDNEY

Dexmedetomidine yog lub hauv paus -2 adrenergic agonist, uas tau pom tias muajanti-inflammatory zog, txo kev tuagthiab attenuating plasma cytokine concentrations hauv cov tsiaj kuaj 5. Dexme-detomidine infusion qhia cov tshuaj tiv thaiv kab mob thaum lub sijhawm thiab tom qab CPB. Cov teebmeem cuam tshuam ntawm dexmedetomidine tej zaum yuav yog vim qhov inhibition ntawm nuclear factor kappa B activation thiab qhia tias intra-operative dexmedetomidine yuav pab tau inhibit inflammatory teb cuam tshuam nrog ischemia-reperfusion raug mob thaum lub sij hawm cardiopulmonary bypass6. Kev tshuaj ntsuam meta-tshaj tawm xyoo 2015 qhia tau hais tias kev siv dexmedetomidine perioperative ua ib qho ntxiv rau kev siv tshuaj loog ua rau txo qis hauv cov ntshav ntawm IL-6, IL-8, thiab TNF- nyob rau hauv ib lub sij hawm ntawm 24 teev. postoperatively 7

Peb xav tias dexmedetomidine tuaj yeem ua rau mob plawv, hlwb, pulmonary, thiabtiv thaiv lub raumrau cov neeg mob mob aortic dissection hom A. Txoj kev tshawb no tsom los tshawb xyuas cov txiaj ntsig ntawm dexmedetomidine rau ntawm lub cevQhov tshwm sim ntawm mob hom A aortic dissection. Ntxiv nrog rau kev tshawb xyuas qhov kawg ntawm kev tuag, txoj kev tshawb no kuj tau tshuaj xyuas qhov muaj feem cuam tshuam ntawm dexmedetomidine ntawm lwm cov ntsiab lus tseem ceeb xws limob stroke, ua pa tsis ua haujlwm, fasciotomy los yog amputation, ECMO,kab mob tom qab phais, mob raum raug mob, tshuaj ntxuav tes tshiab, thiabmob ua pakev nyuaj siab syndromeThaum lub sij hawm postoperative lub sij hawm rau cov neeg mob raug kev phais rau mob hom A aortic dissection.

Cov txheej txheem

Cov ntaub ntawv qhov chaw.

Txoj kev tshawb no tau ua tiav siv cov ntaub ntawv los ntawm Chang Gung Research Database (CGRD) hauv Taiwan. CGRD muaj ntau lub tsev kho mob cov ntaub ntawv kho mob (EMR) los ntawm Chang Gung Medical Foundation (CGMF) los ntawm xya lub tsev kho mob Chang Gung Memorial (CGMH), suav nrog ob lub chaw kho mob, ob lub tsev kho mob hauv cheeb tsam, thiab peb lub tsev kho mob hauv cheeb tsam sab qaum teb mus rau yav qab teb Taiwan. . EMR muaj cov ntaub ntawv tus neeg mob-theem tau los ntawm cov kab kos hluav taws xob kho mob ntawm cov neeg mob tsim los rau kev tswj hwm thiab kev saib xyuas kev noj qab haus huv rau CGMH. Txhua tus kws kho mob los ntawm CGMH tuaj yeem nkag mus rau cov ntaub ntawv rau lawv qhov chaw kho mob. Lub Department of Information Systems Management ntawm CGMH tau koom ua ke thiab tsim txhua tus EMRs los ntawm CGMH yam tsis tau xaiv cov qauv thiab tsim CGRD rau kev tshawb fawb. Cov qauv hauv paus rau CGRD suav nrog feem ntau ntawm cov ntaub ntawv los ntawm EMR rau cov kev tshawb fawb txog kev noj qab haus huv niaj hnub, nrog cuaj cov ntaub ntawv kuaj mob, cov ntaub ntawv kho mob, cov ntaub ntawv kho mob, cov ntaub ntawv kho mob xwm txheej ceev, cov ntaub ntawv kab mob, cov ntaub ntawv kho mob, cov ntaub ntawv them nqi, cov ntaub ntawv kab mob, thiab cov ntaub ntawv phais mob 8. CGRD tau sau EMR ntawm txhua tus neeg mob los ntawm CGMH txij li xyoo 2000. Tshwj xeeb, cov kab mob kev noj qab haus huv tau sau tseg raws li International Classification of Disease, 9th Revision Clinical Modification (ICD-9-CM) codes ua ntej 2016, thiab ICD-10 codes tom qab ntawd. Te txoj kev tshawb fawb tau pom zoo los ntawm lub koom haum tshuaj xyuas pawg thawj coj saib xyuas (IRB) ntawm Chang Gung Memorial Tsev Kho Mob thiab tau lees paub qhov kev tso cai raug zam. Txhua qhov kev tshawb fawb tau ua los ntawm Kev Tshaj Tawm ntawm Helsinki hais txog kev coj ncaj ncees rau kev tshawb fawb kho mob. Txhua txoj hauv kev tau ua los ntawm cov lus qhia thiab cov kev cai.

Kawm cov pej xeem.

Daim duab qhia kev sib koom ua ke yog qhia nyob rau hauv daim duab 1. Qhov no yog ib qho kev tshawb fawb rov qab los ntawm ntau lub tsev kawm ntawv. Cov neeg mob tau pw hauv tsev kho mob tom qab kev phais mob rau hom A aortic dissection thaum Lub Ib Hlis 1, 2014, thiab Kaum Ob Hlis 31, 2018, tau kawm. Cov neeg mob uas muaj tus txheej txheem Taiwanese NHI rau ascending aortic replacements (69,024, 68,043) tau siv los tshuaj xyuas. Cov neeg mob uas tau tshaj tawm cov ntaub ntawv phais mob raug cais tawm. Te Cov neeg mob uas tuag hauv 24 teev tom qab ua haujlwm kuj raug cais tawm. Txhua daim ntawv tshaj tawm kev phais raug tshuaj xyuas los ntawm ob tus kws phais mob plawv kom paub tseeb tias cov neeg mob tau txais npe tau mob Aortic dissection. Tom qab ntawd cov neeg mob tau muab faib ua ob pawg: pawg dexmedetomidine thiab pawg tsis-dexmedetomidine. Cov pab pawg midine tau txheeb xyuas los ntawm kev siv cov cai muab tshuaj (BC24002212) hauv lub sijhawm ua haujlwm tom qab txog li 24 teev.

Comorbidities thiab tshwm sim.

Cov ntaub ntawv pej xeem, cov yam ntxwv kho mob, thiab kev sib kis tau raug txheeb xyuas siv ICD-9-CM lossis NHI cov lej txheej txheem. Cov ntaub ntawv kuaj ua ntej ua ntej, kev kuaj mob tom qab phais, thiab cov ntaub ntawv phais mob tau muab los ntawm cov ntaub ntawv kho mob. Cov txiaj ntsig Perioperative tau tshawb pom los ntawm kev taug qab cov neeg mob cov ntaub ntawv nyob hauv tsev kho mob. Cov txiaj ntsig ntawm kev txaus siab yog cov txiaj ntsig tseem ceeb ntawm kev sib koom ua ke thiab kev tuag hauv tsev kho mob. Cov ntsiab lus ntawm cov txiaj ntsig tseem ceeb yog tag nrho-ua rau kev tuag, mob raum raug mob, delirium, postoperative atrial fibrillation, thiab ua pa tsis ua haujlwm. Qhov hnyav ntawm lub raum raug mob tau raug cais los ntawm Acute Kidney Injury Network (AKIN) cov txheej txheem uas tau pom zoo los ntawm Lub Raum Kab Mob Txhim Kho Kev Txhim Kho Ntiaj Teb (KDIGO) Cov Lus Qhia Txog Kev Ua Haujlwm. Hemo dialysis tau txhais los ntawm Taiwan NHI cov nyiaj them rov qab code rau hemodialysis lossis nruam venovenous hemofiltration dialysis (58,001 lossis 58,018) Delirium tau txhais los ntawm qhov zoo CAM-ICU cov qhab nia ntsuas los ntawm ICU tus kws saib xyuas neeg mob, siv haloperidol rau agitated delirium, thiab confration. Postoperative atrial fibrillation tau txhais los ntawm kev tshuaj xyuas ntawm EKG daim ntawv qhia, siv amiodarone rau kev tswj kev sib dhos, thiab tshuaj xyuas cov ntawv tso tawm. Kev ua pa tsis ua haujlwm raug txheeb xyuas siv ICD-9-CM cov lej kuaj mob. Cov neeg mob tau taug qab mus txog thaum tuag lossis Lub Kaum Ob Hlis 31, 2018, qhov twg los ua ntej.

Kev txheeb cais. Vim muaj ntau qhov kev soj ntsuam uas ploj lawm hauv chav kuaj thiab cov ntaub ntawv phais mob, peb frst imputed qhov tseem ceeb uas ploj lawm siv tib txoj kev cia siab maximization (EM) imputation thiab tsim cov propensity score matching (PSM) cohort. PSM los ntawm ntau qhov sib txawv logistic regression qauv tau ua kom sib npaug ntawm cov yam ntxwv ntawm cov dexmedetomidine thiab non-dexmedetomidine pawg. Txhua rooj plaub ntawm dexmedetomidine tau muab tso rau hauv ob pawg neeg uas tsis yog dexmedetomidine yog tias ua tau. Cov tsis siv los xam cov qhab nia zoo yog hnub nyoog, poj niam txiv neej, kev phais mob plawv yav dhau los, comorbidity, mob ua ntej, cov ntaub ntawv kuaj ua ntej, cov ntaub ntawv phais, thiab kev phais ntxiv (teev nyob rau hauv Table 1). Qhov kev ntshaw siab nyob ze tshaj plaws algorithm tau txais yuav nrog qhov dav caliper ntawm 0.05 tus qauv sib txawv ntawm cov logit ntawm cov qhab nia zoo. Qhov sib txawv kiag li tus qauv (STD) tsawg dua 0.2 tom qab kev sib piv tau txiav txim siab los qhia qhov txawv me me ntawm pawg. Tom qab sib txuam, 72 thiab 14 cov neeg mob hauv dexmedetomidine muaj ob thiab ib tus neeg sib koom ua ke, ua rau tag nrho ntawm 86 cov neeg mob dexmedetomidine thiab 158 tus neeg mob uas tsis muaj dexmedetomidine. Peb cov txheej txheem kev txheeb cais tau piav qhia ua ntej. Hauv kev nthuav dav, cov txiaj ntsig hauv tsev kho mob ntawm dexmedetomidine thiab cov pab pawg tsis yog dexmedetomidine tau muab piv nrog kev sib npaug sib npaug sib npaug (GEE), uas qhov kev ua yuam kev tsis zoo tau kwv yees los suav rau cov txiaj ntsig kev vam khom nyob rau hauv tib khub sib tw. Thaum qhov txuas tau txheeb xyuas, qhov kev faib tawm yog ib txwm ua rau cov txiaj ntsig tsis tu ncua. Thaum qhov txuas yog logit, qhov kev faib tawm yog binomial rau cov txiaj ntsig binary. Te kawm pab pawg yog tib qho kev piav qhia qhov sib txawv hauv cov kev txheeb xyuas qhov kev rov qab los saum toj no. Ib qho ob sab P-tus nqi uas tsawg dua 0.05 tau suav tias yog qhov tseem ceeb, thiab tsis muaj kev hloov pauv ntawm ntau qhov kev sim (ntau ntau) tau ua hauv txoj kev tshawb no. Kev txheeb xyuas txheeb cais tau ua tiav siv SAS version 9.4 (SAS Institute, Cary, NC), suav nrog cov txheej txheem ntawm "patch" rau PSM thiab "genome" rau GEE.

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Tau txais NATURAL ORGANIC CISTANCHE EXTRACT nrog 25% ECHINACOSIDE thiab 9% ACTEOSIDE rau raum kab mob