Roddy Sean P, Darling R Clement, Maharaj Dale, Ozsvath Kathleen J, Mehta Manish, Paty Philip S K, Kreienberg Paul B, Choi Daniel, Chang Benjamin B, Shah Dhiraj M
Albany Medical College, Institute for Vascular Health and Disease MC157, 47 New Scotland Avenue, Albany, NY 12208, USA.
Cardiovasc Surg. 2003 Oct;11(5):337-40. doi: 10.1016/S0967-2109(03)00101-7.
Several investigators have suggested a dismal prognosis of ruptured abdominal aortic aneurysm (rAAA) repair in the elderly. The purpose of this study is to evaluate the morbidity and mortality of rAAA repair in octogenarians and compare it to that of a younger population.
From 1980 to 2000, all patients undergoing emergent rAAA repair were divided into two groups based on their age; Group I: age <80, Group II: > or =80 years. Outcomes were evaluated based on a Chi-square test and a P-value <0.05 indicated statistical significance.
Over a 20-year period, 323 patients underwent rAAA repair through a left retroperitoneal (74%) or standard transperitoneal (26%) approach. In Group I (age <80 years) and II (> or =80 years), the overall 30-day mortality was 25 and 41% (P<0.05), respectively. Furthermore, the elderly population had a higher incidence of death due to myocardial infarction (15 vs. 7%), as well as non-fatal cardiac and cerebrovascular events (17 vs. 4%) when compared to the younger patients.
Although the elderly patients have an increased risk of having cardiac and cerebrovascular events in the postoperative period, the treatment of rAAAs in these patients should not be any different than that of a younger population. The left retroperitoneal approach is feasible and beneficial for rAAA repair and is associated with a limited morbidity and mortality.
几位研究者指出，老年患者腹主动脉瘤破裂（rAAA）修复的预后不佳。本研究的目的是评估八旬老人rAAA修复的发病率和死亡率，并将其与年轻人群进行比较。
1980年至2000年，所有接受急诊rAAA修复的患者根据年龄分为两组；第一组：年龄<80岁，第二组：年龄≥80岁。基于卡方检验评估结果，P值<0.05表示具有统计学意义。
在20年期间，323例患者通过左腹膜后（74%）或标准经腹（26%）入路接受了rAAA修复。在第一组（年龄<80岁）和第二组（年龄≥80岁）中，30天总体死亡率分别为25%和41%（P<0.05）。此外，与年轻患者相比，老年人群因心肌梗死死亡的发生率更高（15%对7%），以及非致命性心脏和脑血管事件的发生率更高（17%对4%）。
尽管老年患者术后发生心脏和脑血管事件的风险增加，但这些患者rAAA的治疗应与年轻人群无异。左腹膜后入路对rAAA修复是可行且有益的，且发病率和死亡率有限。
