Etz Christian D, Di Luozzo Gabriele, Bello Ricardo, Luehr Maximilian, Khan Muhammad Z, Bodian Carol A, Griepp Randall B, Plestis Konstadinos A
Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York 10029, USA.
Ann Thorac Surg. 2007 Feb;83(2):S870-6; discussion S890-2. doi: 10.1016/j.athoracsur.2006.10.099.
Although recent advances in surgical techniques have improved outcomes of descending thoracic (DTA) and thoracoabdominal aortic aneurysm (TAAA) repair, significant mortality and morbidity still occur. The aim of the current retrospective study is to determine predictors of postoperative pulmonary complications and prolonged hospital stay.
Two hundred nineteen patients (median age, 66 years; range, 18 to 88; 112 male) underwent DTA (n = 79 [36%; 23 elephant trunk completions]) or TAAA (n = 140 [64%; Crawford I (52%), II (10%), III (11%), IV (7%); 31 elephant trunk completions]) between June 2002 and June 2005. Forty-one patients presented with ruptured aneurysms. Left atrial-to-femoral bypass was utilized in 51% of the patients. Femorofemoral bypass and distal aortic perfusion were used in 41% of the patients, deep hypothermic circulatory arrest (DHCA) was used in 43 patients (mean duration: 31 +/- 9 minutes); 8% were done with clamp-and-sew technique.
Adverse outcomes were seen in 21 patients (9.5%); hospital death in 13 (5.9%), and stroke in 13 (5 of whom died; 5.9%). Sixty patients (27%) experienced respiratory complications with prolonged postoperative ventilation (longer than 48 hours); 24 required tracheostomy (11%). Independent predictors of pulmonary complications after DTA/TAAA were TAAA (p = 0.03), preoperative blood urea nitrogen greater than 24 mg/dL (p = 0.03) and rupture (p = 0.09). The median hospital stay was 11 days (interquartile range, 6 to 35). Independent predictors of length of hospital stay were preoperative blood urea nitrogen (p = 0.045), postoperative bleeding (p < 0.005), reintubation (p = 0.001), tracheostomy (p < 0.0005), and transfusion of platelets (p = 0.008).
This contemporary experience demonstrates that preoperative renal insufficiency and extensive aneurysm are important predictors of respiratory complications after aortic aneurysm surgery.
尽管外科技术的最新进展改善了降主动脉（DTA）和胸腹主动脉瘤（TAAA）修复的效果，但仍有显著的死亡率和发病率。本回顾性研究的目的是确定术后肺部并发症和住院时间延长的预测因素。
2002年6月至2005年6月期间，219例患者（中位年龄66岁；范围18至88岁；男性112例）接受了DTA（n = 79 [36%；23例象鼻术完成]）或TAAA（n = 140 [64%；克劳福德I型（52%），II型（10%），III型（11%），IV型（7%）；31例象鼻术完成]）手术。41例患者为动脉瘤破裂。51%的患者采用左心房至股动脉旁路转流。41%的患者采用股股旁路转流和主动脉远端灌注，43例患者采用深低温停循环（DHCA）（平均持续时间：31±9分钟）；8%采用钳夹缝合技术。
21例患者（9.5%）出现不良结局；13例（5.9%）住院死亡，13例（其中5例死亡；5.9%）发生卒中。60例患者（27%）出现呼吸并发症，术后通气时间延长（超过48小时）；24例需要气管切开（11%）。DTA/TAAA术后肺部并发症的独立预测因素为TAAA（p = 0.03）、术前血尿素氮大于24 mg/dL（p = 0.03）和破裂（p = 0.09）。中位住院时间为11天（四分位间距，6至35天）。住院时间的独立预测因素为术前血尿素氮（p = 0.045）、术后出血（p < 0.005）、再次插管（p = 0.001）、气管切开（p < 0.0005）和血小板输注（p = 0.008）。
这一当代经验表明，术前肾功能不全和广泛的动脉瘤是主动脉瘤手术后呼吸并发症的重要预测因素。
