Department of Cardiovascular Surgery, Swiss Cardiovascular Centre, University Hospital Bern and University of Bern, Bern, Switzerland.
J Vasc Surg. 2013 Apr;57(4):943-50. doi: 10.1016/j.jvs.2012.09.072. Epub 2013 Jan 18.
In acute traumatic bleeding, permissive arterial hypotension with delayed volume resuscitation is an established lifesaving concept as abridge to surgical control. This study investigated whether preoperatively administered volume also correlated inversely with survival after ruptured abdominal aortic aneurysm (rAAA).
This retrospective study analyzed prospectively collected and validated data of a consecutive cohort of patients with rAAAs (January 2001 to December 2010). Generally, fluid resuscitation was guided clinically by the patient's blood pressure and consciousness. All intravenous fluids (crystalloids, colloids, and blood products) administered before aortic clamping or endovascular sealing were abstracted from paramedic and anesthesia documentation and normalized to speed of administration (liters per hour). Logistic regression modeling, adjusted for suspected confounding covariates, was used to investigate whether total volume was independently associated with risk of death within 30 days of rAAA repair.
A total of 248 patients with rAAAs were analyzed, of whom 237 (96%) underwent open repair. A median of 0.91 L of total volume per hour (interquartile range, 0.54-1.50 L/h) had been administered preoperatively to these patients. The postoperative 30-day mortality rate was 15.3% (38 deaths). The preoperative rate of fluid infusion correlated with 30-day mortality after adjustment for confounding factors, and the association persisted robustly through sensitivity analyses: each additional liter per hour increased the odds of perioperative death by 1.57-fold (95% confidence interval, 1.06-2.33; P = .026).
Aggressive volume resuscitation of patients with rAAAs before proximal aortic control predicted an increased perioperative risk of death, which was independent of systolic blood pressure. Therefore, volume resuscitation should be delayed until surgical control of bleeding is achieved.
在急性创伤性出血中，允许性动脉低血压伴延迟容量复苏是一种已确立的救命概念，可作为通向手术控制的桥梁。本研究旨在探讨破裂性腹主动脉瘤（rAAA）患者术前给予的容量是否也与生存呈反比关系。
本回顾性研究分析了连续队列的前瞻性收集和验证数据rAAA 患者（2001 年 1 月至 2010 年 12 月）。通常，根据患者的血压和意识，临床指导液体复苏。从护理人员和麻醉记录中提取并标准化到给药速度（每小时升）所有在主动脉夹闭或血管内密封之前给予的静脉输液（晶体液、胶体液和血液制品）。使用逻辑回归建模，调整可疑混杂协变量，调查总容量是否与 rAAA 修复后 30 天内死亡风险独立相关。
共分析了 248 例 rAAA 患者，其中 237 例（96%）接受了开放修复。这些患者术前平均每小时输注 0.91 升总容量（四分位距，0.54-1.50 L/h）。术后 30 天死亡率为 15.3%（38 例死亡）。调整混杂因素后，术前输液率与 30 天死亡率相关，且该关联在敏感性分析中仍然稳健：每增加 1 升/小时，围手术期死亡的几率增加 1.57 倍（95%置信区间，1.06-2.33；P=0.026）。
在近端主动脉控制前积极对 rAAA 患者进行容量复苏预测围手术期死亡风险增加，这与收缩压无关。因此，应延迟容量复苏，直到达到出血的手术控制。
