Makar Ragai R, Badger Stephen A, O'Donnell Mark E, Loan William, Lau Louis L, Soong Chee V
Vascular and Endovascular Surgery Department, Belfast City Hospital, Belfast, Northern Ireland, United Kingdom.
J Vasc Surg. 2009 Apr;49(4):866-72. doi: 10.1016/j.jvs.2008.11.027.
This study assessed if emergency endovascular repair (eEVR) reduces the increase in intra-abdominal compartment pressure and host inflammatory response in patients with ruptured abdominal aortic aneurysm (AAA).
Thirty patients with ruptured AAA were prospectively recruited. Patients were offered eEVR or emergency conventional open repair (eOR) depending on anatomic suitability. Intra-abdominal pressure was measured postoperatively, at 2 and 6 hours, and then daily for 5 days. Organ dysfunction was assessed preoperatively by calculating the Hardman score. Multiple organ dysfunction syndrome, systemic inflammatory response syndrome, and lung injury scores were calculated regularly postoperatively. Hematologic analyses included serum urea and electrolytes, liver function indices, and C-reactive protein. Urine was analyzed for the albumin-creatinine ratio.
Fourteen patients (12 men; mean age, 72.2 +/- 6.2 years) underwent eEVR, and 16 (14 men; mean age, 71.4 +/- 7.0 years) had eOR. Intra-abdominal pressure was significantly higher in the eOR cohort compared with the eEVR group. The eEVR patients had significantly less blood loss (P < .001) and transfused (P < .001) and total intraoperative intravenous fluid infusion (P = .001). The eOR group demonstrated a greater risk of organ dysfunction, with a higher systemic inflammatory response syndrome score at day 5 (P = .005) and higher lung injury scores at days 1 and 3 (P = .02 and P = .02) compared with eEVR. A significant correlation was observed between intra-abdominal pressure and the volume of blood lost and transfused, amount of fluid given, systemic inflammatory response syndrome score, multiple organ dysfunction score, lung injury score, and the length of stay in the intensive care unit and hospital.
These results suggest that eEVR of ruptured AAA is less stressful and is associated with less intra-abdominal hypertension and host inflammatory response compared with eOR.
本研究评估急诊血管腔内修复术（eEVR）是否能降低腹主动脉瘤破裂（AAA）患者的腹腔内压升高和宿主炎症反应。
前瞻性招募30例AAA破裂患者。根据解剖学适宜性，为患者提供eEVR或急诊传统开放修复术（eOR）。术后、术后2小时和6小时测量腹腔内压，然后连续5天每天测量。术前通过计算哈德曼评分评估器官功能障碍。术后定期计算多器官功能障碍综合征、全身炎症反应综合征和肺损伤评分。血液学分析包括血清尿素和电解质、肝功能指标以及C反应蛋白。分析尿液中的白蛋白-肌酐比值。
14例患者（12例男性；平均年龄72.2±6.2岁）接受了eEVR，16例（14例男性；平均年龄71.4±7.0岁）接受了eOR。与eEVR组相比，eOR队列中的腹腔内压显著更高。eEVR患者的失血量（P < .001）、输血量（P < .001）和术中总静脉输液量（P = .001）明显更少。与eEVR相比，eOR组显示出更大的器官功能障碍风险，在第5天全身炎症反应综合征评分更高（P = .005），在第1天和第3天肺损伤评分更高（P = .02和P = .02）。观察到腹腔内压与失血量和输血量、输液量、全身炎症反应综合征评分、多器官功能障碍评分、肺损伤评分以及重症监护病房和医院住院时间之间存在显著相关性。
这些结果表明，与eOR相比，AAA破裂的eEVR压力更小，与腹腔内高压和宿主炎症反应更少相关。
