主动脉创伤性破裂：即刻修复还是延迟修复？
Traumatic rupture of the aorta: immediate or delayed repair?
作者信息
Symbas Panagiotis N, Sherman Andrew J, Silver Jeffery M, Symbas John D, Lackey Jodi J
机构信息
Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine and Grady Memorial Hospital, Atlanta, Georgia, USA.
出版信息
Ann Surg. 2002 Jun;235(6):796-802. doi: 10.1097/00000658-200206000-00006.
OBJECTIVE
To determine whether delay of the repair of the ruptured thoracic aorta in patients with other major injuries is safe and has a potential positive impact on survival.
SUMMARY BACKGROUND DATA
The accepted treatment for acute traumatic rupture of the thoracic aorta has been repair of the injury as soon as possible. This form of management, however, has been accompanied by a death rate of 0% to 54% mortality, often related to the presence of other injuries.
METHODS
The records of 30 consecutive patients with rupture of the thoracic aorta from blunt trauma treated from 1995 to 2001 were retrospectively reviewed. Two of them died shortly after admission and were excluded from further consideration. The remaining 28 patients were divided according to the time of the repair of the rupture into two groups. Group 1 patients underwent repair of the rupture immediately after the diagnosis was made. Group 2 patients, who had associated injuries that were likely to increase the risk of surgical death, had either repair more than 48 hours after injury (subgroup 2A) or had no repair (subgroup 2B). The patients in group 2 had their mean arterial pressure maintained at less than 70 mm Hg with medication to eliminate shear stress on the aortic tear while being observed.
RESULTS
Twenty-eight patients (22 men, 6 women) with an average age of 36 years (range 19-76) were treated. Twenty-five had rupture of the descending thoracic aorta and three had rupture in the ascending thoracic aorta. Group 1 comprised 14 patients, 5 of whom died during surgery or in the early postoperative period. Group 2 comprised 14 patients, 9 in subgroup 2A and 5 in subgroup 2B. Two patients in subgroup 2A and three patients in subgroup 2B died of associated injuries or illnesses. Rupture of the traumatic pseudoaneurysm of the thoracic aorta did not occur in any of the patients in group 2.
CONCLUSIONS
Delayed repair of acute traumatic aortic rupture is safe under appropriate treatment and should be considered in selected patients.
目的
确定在伴有其他严重损伤的患者中，延迟修复胸主动脉破裂是否安全，以及对生存是否有潜在的积极影响。
总结背景数据
对于胸主动脉急性创伤性破裂，公认的治疗方法是尽快修复损伤。然而，这种治疗方式的死亡率为0%至54%，通常与其他损伤的存在有关。
方法
回顾性分析1995年至2001年期间连续收治的30例钝性创伤导致胸主动脉破裂患者的病历。其中2例入院后不久死亡，未纳入进一步分析。其余28例患者根据破裂修复时间分为两组。第1组患者在诊断后立即进行破裂修复。第2组患者伴有可能增加手术死亡风险的相关损伤，在受伤后48小时以上进行修复（2A亚组）或未进行修复（2B亚组）。第2组患者在观察期间通过药物将平均动脉压维持在70 mmHg以下，以消除主动脉撕裂处的剪切应力。
结果
共治疗28例患者（22例男性，6例女性），平均年龄36岁（19 - 76岁）。25例为胸降主动脉破裂，3例为胸升主动脉破裂。第1组包括14例患者，其中5例在手术期间或术后早期死亡。第2组包括14例患者，2A亚组9例，2B亚组5例。2A亚组2例患者和2B亚组3例患者死于相关损伤或疾病。第2组患者均未发生胸主动脉创伤性假性动脉瘤破裂。
结论
在适当治疗下，延迟修复急性创伤性主动脉破裂是安全的，应在特定患者中考虑。
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