Aburahma A F, Woodruff B A, Stuart S P, Lucente F C, Boland J P
Department of Surgery, West Virginia University Health Sciences Center/Charleston Area Medical Center.
Am J Emerg Med. 1991 Mar;9(2):118-21. doi: 10.1016/0735-6757(91)90170-o.
The hospital records of patients treated with ruptured abdominal aortic aneurysm in a recent 5-year period were reviewed to collect data on factors which may be associated with mortality. Overall mortality was 62%. Patients with intraperitoneal rupture had a higher mortality (97%) than patients with retroperitoneal rupture (25%). Patients at increased risk were older than 80 years, presented with syncope, experienced a short duration of symptoms prior to emergency department (ED) arrival, had initial systolic blood pressure less than 90 mm Hg, and/or initial hemoglobin level less than eight on arrival at the ED and delay in beginning surgery. Multivariate analysis demonstrated preoperative blood pressure, preoperative hemoglobin, presence of syncope, and the amount of blood transfused were largely reflections of the type of rupture and had only slight independent relationship to mortality. The authors concluded that treating emergency physicians and surgeons have little control over the most important risk factors for mortality after aneurysm rupture, but may improve the prognosis by expediting diagnosis in the ED and surgical therapy.
回顾了最近5年接受腹主动脉瘤破裂治疗患者的医院记录，以收集可能与死亡率相关因素的数据。总体死亡率为62%。腹腔内破裂患者的死亡率（97%）高于腹膜后破裂患者（25%）。风险增加的患者年龄超过80岁，出现晕厥，在急诊科（ED）就诊前症状持续时间短，到达ED时初始收缩压低于90 mmHg，和/或初始血红蛋白水平低于8，以及手术开始延迟。多变量分析表明，术前血压、术前血红蛋白、晕厥的存在以及输血量在很大程度上反映了破裂类型，与死亡率仅有轻微的独立关系。作者得出结论，治疗急症医生和外科医生对动脉瘤破裂后死亡率的最重要风险因素几乎无法控制，但可通过在ED中加快诊断和手术治疗来改善预后。
