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性别对非心脏血管手术后预后的影响。

The impact of gender on prognosis after non-cardiac vascular surgery.

机构信息

Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.

出版信息

Eur J Vasc Endovasc Surg. 2011 Oct;42(4):510-6. doi: 10.1016/j.ejvs.2011.06.029. Epub 2011 Jul 26.

Abstract

OBJECTIVES

The objective was to evaluate the impact of gender on long-term survival of patients who underwent non-cardiac vascular surgery.

DESIGN, MATERIAL AND METHODS: Our prospectively collected data contained information on 560 patients undergoing carotid endarterectomy (CEA), 923 elective abdominal aortic aneurysm repairs (AAA) and 1046 lower limb reconstructions (LLR). Patient characteristics and long-term mortality of women were compared to that of men. Kaplan-Meier (KM) survival curves were constructed for men and women, on which we superimposed age- and sex-matched KM survival curves of the general population. Cox proportional hazards regression was used to identify risk factors for mortality.

RESULTS

Men in the CEA group had statistically significant higher all-cause mortality, hazard rate ratio (HRR) 1.41 (95% CI 1.01-1.98) No differences in mortality between the genders were observed in the AAA and LLR groups. Overall, men had more co-morbidities but received more disease-specific medication compared to women. Women retained their higher life expectancy after CEA but lost it in the AAA and LLR groups.

CONCLUSION

Women retain their higher life expectancy after CEA; however, after AAA repair and LLR, this advantage is lost. Both men and women received too little disease-specific medication, but women were worse off.

摘要

目的

评估性别对非心脏血管手术患者长期生存的影响。

设计、材料和方法:我们前瞻性收集的数据包含了 560 例颈动脉内膜切除术(CEA)、923 例择期腹主动脉瘤修复术(AAA)和 1046 例下肢重建术(LLR)患者的信息。将女性患者的特征和长期死亡率与男性进行比较。为男性和女性绘制 Kaplan-Meier(KM)生存曲线,并在其上叠加一般人群中年龄和性别匹配的 KM 生存曲线。使用 Cox 比例风险回归来确定死亡率的危险因素。

结果

CEA 组男性的全因死亡率有统计学意义,危险率比(HRR)为 1.41(95%置信区间 1.01-1.98)。AAA 和 LLR 组中,两性之间的死亡率无差异。总体而言,男性的合并症更多,但接受的疾病特异性药物治疗比女性更多。女性在 CEA 后保持较高的预期寿命,但在 AAA 和 LLR 组中失去了这一优势。

结论

女性在 CEA 后仍保持较高的预期寿命;然而,在接受 AAA 修复和 LLR 后,这种优势就消失了。男性和女性都接受了太少的疾病特异性药物治疗,但女性的情况更糟。

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