Predisposing factors, management, and prognostic evaluation of acute carotid blowout syndrome
Predisposing factors, management, and prognostic evaluation of acute carotid blowout syndrome
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DOI：
10.1016/j.jvs.2013.04.056
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发表时间：
2013-11-01
影响因子：
4.3
通讯作者：
Yang, Muh-Hwa
中科院分区：
文献类型：
--
作者：
Lu, Hsueh-Ju;Chen, Kuo-Wei;Yang, Muh-Hwa
背景：6%-10%的晚期癌症患者发生大面积转移。急性颈动脉爆裂综合征是头颈部癌症患者最严重的大出血并发症。方法：这是一项单一研究所、回顾性、病例对照研究。本研究共入组45例患者。结果：在基线特征中，原发肿瘤的部位（P = .003）、出血来源（P = .048）、干预方法（P = .005）和干预时间（P = .006）是生存者和非生存者患者之间存在显著差异的因素。发病24小时后，格拉斯哥昏迷量表评分（P = .000）、使用正性肌力药（P = .007）和嗜中性粒细胞/淋巴细胞比值（P = .019）是显著的预后预测因素。多因素Logistic回归分析显示颈总动脉出血是长期生存的独立因素（优势比，25.951; 95%可信区间[CI]，1.373-490.441; P <0.030）。生存者和非生存者的中位总生存期为12.1（范围，3.7-118.7; 95% CI，4.33-54.87）和11.9（范围，0.7-53.5; 95% CI，5.78-25.69）个月结论：早期积极干预对成功治疗急性颈动脉爆裂综合征非常重要。格拉斯哥昏迷量表评分、正性肌力药的使用和发病后24小时嗜中性粒细胞/淋巴细胞比率是患者预后的预测因素。在多因素分析中，颈总动脉出血是独立的预后因素。成功治疗后可获得长期生存。
Background: Massive hemorrhages occur in 6%-10% of patients with advanced cancer. Acute carotid blowout syndrome is the most severe massive hemorrhagic complication in head and neck cancer patients.Methods: This was a single institute, retrospective, case control study. A total of 45 patients were enrolled in this study. The predisposing factors, management, and prognosis of acute carotid blowout syndrome were evaluated.Results: Among the baseline characteristics, the site of the primary tumor (P = .003), origin of bleeding (P = .048), method of intervention (P = .005), and time to intervention (P = .006) were significantly different factors between survivor and nonsurvivor patients. After 24 hours of onset, a Glasgow Coma Scale score (P = .000), the use of inotropic agents (P = .007), and neutrophil-to-lymphocyte ratio (P = .019) were significantly predicting factors for outcome. Multivariate logistic regression analyses revealed bleeding from common carotid artery was an independent factor for long-term survival (odds ratio, 25.951; 95% confidence interval [CI], 1.373-490.441; P < .030). The median overall survival of survivors and nonsurvivors were 12.1 (range, 3.7-118.7; 95% CI, 4.33-54.87) and 11.9 (range, 0.7-53.5; 95% CI, 5.78-25.69) months, respectively (P = .092).Conclusions: Early and aggressive intervention is important for the successful management of acute carotid blowout syndrome. The Glasgow Coma Scale score, the use of inotropic agents, and neutrophil-to-lymphocyte ratio 24 hours after the onset were predictive factors for patients' outcomes. Bleeding from common carotid artery is an independent prognostic factor in multivariate analysis. Long-term survival can be achieved after successful management.