Sasaki S, Sakuma M, Samejima M, Kunihara T, Shiiya N, Murashita T, Matsui Y, Yasuda K
Department of Cardiovascular Surgery, Hokkaido University Hospital, Sapporo, Japan.
J Cardiovasc Surg (Torino). 1999 Jun;40(3):401-5.
Rupture is often the first manifestation in patients with abdominal aortic aneurysms. Although elective surgery for non-ruptured abdominal aortic aneurysms has provided satisfactory surgical results, operative mortality of ruptured abdominal aortic aneurysms (rAAA) has not improved. The purpose of this study was to identify predictors for early hospital death in patients with rAAA.
A retrospective study.
A university hospital and 20 affiliated hospitals.
PATIENTS undergoing surgical treatment for rAAA (n=183) between 1968 and 1997.
All patients were surgically treated and divided into operative survivors (n=119) and non-survivors (n=64).
The patient-related, procedure-related, and postoperative factors were compared between the two groups. A multivariate analysis was also conducted to determine predictors for hospital deaths.
In univariate analysis, age at operation (p=0.004), preoperative hemodynamic conditions (p<0.0001), extent of hematoma (p<0.0001), preexistent renal dysfunction (p=0.001), and volumes of blood loss at operation (p=0.001) were significantly different between the two groups. The morbidity of postoperative renal failure (p<0.0001), gut ischemia (p=0.003), heart failure or ischemic heart disease (p<0.0001), and multiple organ dysfunction syndrome (p<0.0001) was higher in the non-survivors' group. Multivariate analysis also identified preoperative hemodynamic conditions, blood loss volume at operation, pre-existent renal dysfunction, postoperative renal failure, heart failure, and multiple organ dysfunction syndrome as incremental risk factors for hospital deaths.
Every effort to maintain preoperative hemodynamic conditions, to reduce volumes of blood loss at operation, and to minimize deterioration of organ functions postoperatively is all essential to improve patient survival.
破裂常是腹主动脉瘤患者的首发表现。尽管非破裂性腹主动脉瘤的择期手术已取得令人满意的手术效果，但破裂性腹主动脉瘤（rAAA）的手术死亡率并未改善。本研究的目的是确定rAAA患者早期院内死亡的预测因素。
一项回顾性研究。
一所大学医院及20家附属医院。
1968年至1997年间接受rAAA手术治疗的患者（n = 183）。
所有患者均接受手术治疗，并分为手术存活者（n = 119）和非存活者（n = 64）。
比较两组患者的患者相关因素、手术相关因素及术后因素。还进行了多因素分析以确定院内死亡的预测因素。
单因素分析显示，两组患者的手术年龄（p = 0.004）、术前血流动力学状况（p < 0.0001）、血肿范围（p < 0.0001）、术前存在的肾功能不全（p = 0.001）及手术失血量（p = 0.001）有显著差异。非存活者组术后肾衰竭（p < 0.0001）、肠道缺血（p = 0.003）、心力衰竭或缺血性心脏病（p < 0.0001）及多器官功能障碍综合征（p < 0.0001）的发病率更高。多因素分析还确定术前血流动力学状况、手术失血量、术前存在的肾功能不全、术后肾衰竭、心力衰竭及多器官功能障碍综合征是院内死亡的增加危险因素。
尽一切努力维持术前血流动力学状况、减少手术失血量并使术后器官功能恶化最小化对于提高患者生存率至关重要。
