Hatori N, Yoshizu H, Shimizu M, Hinokiyama K, Takeshima S, Kimura T, Iizuka Y, Tanaka S
Department of Surgery II, National Defense Medical College, Tokorozawa, Saitama, Japan.
Surg Today. 2000;30(9):785-90. doi: 10.1007/s005950070059.
Although the operative mortality following elective aneurysmectomy has achieved satisfactory results, that following surgery for ruptured abdominal aortic aneurysms (AAAs) remains high. The purpose of this study was to identify the factors affecting the mortality rate associated with the treatment of ruptured AAAs. Between 1978 and 1999, 33 patients underwent emergency surgery for a ruptured AAA. The operative mortality was 33.3% and in-hospital mortality was 6.0%. Hypotension, defined as a systolic blood pressure <80 mmHg, was seen in 19 patients at the time of presentation, 9 of whom underwent surgery in this state. In the remaining 10 patients, it was possible to increase the systolic blood pressure to > or =80 mmHg preoperatively. Of the 11 patients who died within 30 days of surgery, 9 had hypotension at the time of induction of anesthesia and only 2 had a systolic blood pressure of > or =80 mmHg. A satisfactory outcome was achieved in patients whose condition met the following criteria: a systolic blood pressure > or =80 mmHg at the time of operation, minimal aortic cross-clamping time, less blood loss and blood transfusions, and a shorter operation time to repair the ruptured AAA. Concomitant heart disease was also found to be an important prognostic factor.
尽管择期动脉瘤切除术后的手术死亡率已取得令人满意的结果，但腹主动脉瘤（AAA）破裂手术后的死亡率仍然很高。本研究的目的是确定影响AAA破裂治疗相关死亡率的因素。1978年至1999年间，33例患者因AAA破裂接受了急诊手术。手术死亡率为33.3%，住院死亡率为6.0%。表现时收缩压<80 mmHg定义为低血压，19例患者在就诊时有低血压，其中9例在这种状态下接受了手术。在其余10例患者中，术前有可能将收缩压提高到≥80 mmHg。在术后30天内死亡的11例患者中，9例在麻醉诱导时有低血压，只有2例收缩压≥80 mmHg。病情符合以下标准的患者取得了满意的结果：手术时收缩压≥80 mmHg、主动脉交叉阻断时间最短、失血量和输血量较少以及修复破裂AAA的手术时间较短。合并心脏病也被发现是一个重要的预后因素。
