Rinckenbach Simon, Albertini Jean-Noel, Thaveau Fabien, Steinmetz Eric, Camin Amélie, Ohanessian Lionel, Monassier François, Clément Claude, Brenot Roger, Camelot Gabriel, Chakfé Nabil, Kretz Jean-Georges
Service de Chirurgie Vasculaire, Hôpital Jean Minjoz, CHU de Besançon, Besançon Cedex, France.
Ann Vasc Surg. 2010 Apr;24(3):308-14. doi: 10.1016/j.avsg.2009.08.011. Epub 2010 Jan 6.
The aim of this study was to evaluate the quality of the current treatment of patients presenting with ruptured abdominal aortic aneurysms (RAAAs), from the first symptoms to the operating room with an analysis of preoperative mortality risk factors.
For 3 years, in four vascular surgery departments, we have collected all the consecutive cases of patients operated on for RAAA. We analyzed the initial clinical situation, the means of transportation, the time elapsed before treatment, and the mortality rate at 3 days. Sixty-six RAAAs were operated on. Mean patient age was 76 years (range, 52-93 years).
The initial symptoms were a precisely located pain either abdominal (45.3%), lumbar (17.2%), or both (14.1%) or feeling faint (10.9%). In 22.7% of the cases, an initial hemodynamic instability was observed. In 46.8% of the cases, patients first went to a peripheral hospital before being admitted into a referral centre. In 84.5% of the cases, medical mean of transportation was used. The mean distance covered was 59.8 kilometers (range, <5 km to 213 km). The initial diagnosis was accurate in 67.3% of the cases. The mean intrahospital waiting period between the arrival at a reference center and the admission into an operating room was 127 minutes. Global mortality rate was 44.2%. The main preoperative mortality factor to be noticed was the initial hemodynamic instability (p=0.0031). Among stable patients, only two of them (5.4%) worsened during the preoperative treatment.
In our study, hemodynamic instability corresponds to the main prognosis factor of mortality. In most cases, the initial stability persisted and allowed additional evaluation. However, the intrahospital waiting periods appeared to be too long. To be optimal, the adequate treatment should be specifically designed as soon as a diagnosis has been established.
本研究旨在评估腹主动脉瘤破裂（RAAA）患者从出现首发症状到进入手术室的当前治疗质量，并分析术前死亡风险因素。
连续3年，在四个血管外科科室，我们收集了所有接受RAAA手术的连续病例。我们分析了初始临床情况、转运方式、治疗前经过的时间以及3天的死亡率。共对66例RAAA患者进行了手术。患者平均年龄为76岁（范围52 - 93岁）。
首发症状为定位明确的腹痛（45.3%）、腰痛（17.2%）或两者皆有（14.1%），或头晕（10.9%）。22.7%的病例出现初始血流动力学不稳定。46.8%的病例中，患者首先前往周边医院，然后才被收入转诊中心。84.5%的病例采用医疗转运方式。平均转运距离为59.8公里（范围<5公里至213公里）。67.3%的病例初始诊断准确。到达参考中心至进入手术室的院内平均等待时间为127分钟。总体死亡率为44.2%。需注意的主要术前死亡因素是初始血流动力学不稳定（p = 0.0031）。在稳定患者中，仅有两人（5.4%）在术前治疗期间病情恶化。
在我们的研究中，血流动力学不稳定是死亡率的主要预后因素。在大多数情况下，初始稳定性得以维持并允许进行进一步评估。然而，院内等待时间似乎过长。为达到最佳效果，一旦确诊就应专门设计适当的治疗方案。
