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单一先天性肝外门体分流手术矫正后发生减毒后癫痫发作的犬短期生存预后因素:93例病例(2005 - 2018年)

Prognostic factors for short-term survival of dogs that experience postattenuation seizures after surgical correction of single congenital extrahepatic portosystemic shunts: 93 cases (2005-2018).

作者信息

Mullins Ronan A, Sanchez Villamil Carlos, Selmic Laura E, Tivers Michael S, Case J Brad, Singh Ameet, Thieman Mankin Kelley M, Anderson Davina M, White Robert N, Pratschke Kathryn M, de Rooster Hilde, Kummeling Anne, Yool Donald A, Olive Melanie, Dr Vét Jean-Philippe Billet, Gordo Ines, Brissot Herve, Broome Cameron, Kirby Barbara M

机构信息

Section of Veterinary Clinical Sciences, University College Dublin, Belfield, Dublin, Ireland.

Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio.

出版信息

Vet Surg. 2020 Jul;49(5):958-970. doi: 10.1111/vsu.13422. Epub 2020 Apr 4.

Abstract

OBJECTIVE

To identify prognostic factors for short-term survival of dogs that experience seizures within 7 days after surgical correction of single congenital extrahepatic portosystemic shunts (cEHPSS).

STUDY DESIGN

Multi-institutional retrospective study.

SAMPLE POPULATION

Ninety-three client-owned dogs.

METHODS

Medical records at 14 veterinary institutions were reviewed to identify dogs that underwent surgical attenuation of a single cEHPSS from January 1, 2005 through February 28, 2018 and experienced postattenuation seizures (PAS) within 7 days postoperatively. Logistic regression analysis was performed to identify factors associated with 1-month survival. Factors investigated included participating institution, signalment, shunt morphology, concurrent/historical conditions, presence of preoperative neurologic signs, presence of preoperative seizures, aspects of preoperative medical management, surgical details including method and degree of shunt attenuation, type of PAS (focal only or generalized ± focal), drugs administered as part of the treatment of PAS, and development of complications during treatment of PAS.

RESULTS

Thirty (32.3%) dogs survived to 30 days. Seventy-six (81.7%) dogs experienced generalized PAS. Factors positively associated with short-term survival included having a history of preoperative seizures (P = .004) and development of focal PAS only (P = .0003). Most nonsurvivors were humanely euthanized because of uncontrolled or recurrent seizures.

CONCLUSION

Dogs that experienced PAS that had a history of preoperative seizures and those that experienced focal PAS only had significantly improved short-term survival.

CLINICAL SIGNIFICANCE

The results of this study provide information that will help in the counseling of owners who seek treatment for PAS after surgical correction of cEHPSS. © 2020 The American College of Veterinary Surgeons.

摘要

目的

确定在单一先天性肝外门体分流(cEHPSS)手术矫正后7天内发生癫痫发作的犬短期生存的预后因素。

研究设计

多机构回顾性研究。

样本群体

93只客户拥有的犬。

方法

回顾了14家兽医机构的病历,以确定2005年1月1日至2018年2月28日期间接受单一cEHPSS手术减流且术后7天内发生减流后癫痫发作(PAS)的犬。进行逻辑回归分析以确定与1个月生存相关的因素。研究的因素包括参与机构、特征、分流形态、并发/既往病症、术前神经学体征的存在、术前癫痫发作的存在、术前医疗管理方面、手术细节(包括分流减流的方法和程度)、PAS类型(仅局灶性或全身性±局灶性)、作为PAS治疗一部分给予的药物以及PAS治疗期间并发症的发生。

结果

30只(32.3%)犬存活至30天。76只(81.7%)犬发生全身性PAS。与短期生存呈正相关的因素包括有术前癫痫发作史(P = 0.004)和仅发生局灶性PAS(P = 0.0003)。大多数非存活犬因癫痫发作无法控制或复发而被人道安乐死。

结论

有术前癫痫发作史且仅发生局灶性PAS的犬短期生存显著改善。

临床意义

本研究结果提供的信息将有助于为寻求cEHPSS手术矫正后PAS治疗的犬主提供咨询。© 2020美国兽医外科医师学会。

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