Gierek Danuta, Cyzowski Tomasz, Kaczmarska Adrianna, Janowska-Rodak Anna, Budziarz Barbara, Koczur Tomasz
Department of Anaesthesiology and Intensive Therapy, University Hospital No 7, Medical University of Silesia in Katowice, Poland.
Anaesthesiol Intensive Ther. 2013 Jan-Mar;45(1):25-9. doi: 10.5603/AIT.2013.0005.
The incidence of abdominal aortic aneurysm has been estimated at 20-40 cases per 100,000 per annum. The disease is often asymptomatic; in many cases, its first symptom is shock caused by a ruptured aneurysm. The aim of the present study was to assess retrospectively the selected perioperative factors in patients hospitalised in the intensive care unit (ICU) after repair of ruptured abdominal aortic aneurysm.
Analysis involved medical records of patients after repair of ruptured abdominal aortic aneurysm treated in ICU in the years 2009-2010. Patients were divided into two groups: group I - survivors who were discharged from ICU and group II - non-survivors. Demographic factors, intraoperative data, vital parameters, laboratory results and severity of patient's state on admission to ICU were analysed.
Analysis of laboratory results on admission to ICU showed lower values of pH and HCO(3)(-) concentrations as well as higher international normalised ratio (INR) and activated partial thromboplastin time (APTT) in group II. Mean intraoperative diuresis differed between the groups; in group I - 303 mL and in group II - 155 mL. Mean diuresis on ICU day 1 was higher in group I compared to group II, i.e. 20.87 and 11.27 mL kg b.w.-1, respectively. APACHE II, SAPS II, MODS and SOFA point values were higher in group I than in group II.
Markers of impaired homeostasis, such as pH, HCO(3)(-) concentration, INR and APTT assessed on admission to ICU can be relevant prognostic factors in patients after repair of ruptured abdominal aortic aneurysm. Monitoring of diuresis during surgery and on day 1 of ICU treatment was a sensitive risk marker for acute kidney injury. Multiple organ failure scales such as APACHE II, MODS, SOFA and SAPS II were reliable prognostic tools to be used in the early period of ICU treatment.
据估计，腹主动脉瘤的发病率为每年每10万人中有20 - 40例。该病通常无症状；在许多情况下，其首发症状是动脉瘤破裂引起的休克。本研究的目的是回顾性评估破裂腹主动脉瘤修复术后入住重症监护病房（ICU）患者的选定围手术期因素。
分析2009 - 2010年在ICU接受治疗的破裂腹主动脉瘤修复术后患者的病历。患者分为两组：第一组为从ICU出院的幸存者，第二组为非幸存者。分析了人口统计学因素、术中数据、生命体征参数、实验室检查结果以及患者入住ICU时的病情严重程度。
对入住ICU时的实验室检查结果分析显示，第二组的pH值和HCO₃⁻浓度较低，国际标准化比值（INR）和活化部分凝血活酶时间（APTT）较高。两组的术中平均尿量不同；第一组为303 mL，第二组为155 mL。第一组在ICU第1天的平均尿量高于第二组，分别为20.87和11.27 mL·kg体重⁻¹。第一组的急性生理与慢性健康状况评分系统II（APACHE II）、简化急性生理学评分II（SAPS II）、多器官功能障碍评分（MODS）和序贯器官衰竭评估（SOFA）分值高于第二组。
入住ICU时评估的内环境稳态受损指标，如pH值、HCO₃⁻浓度、INR和APTT，可能是破裂腹主动脉瘤修复术后患者的相关预后因素。手术期间及ICU治疗第1天的尿量监测是急性肾损伤的敏感风险标志物。急性生理与慢性健康状况评分系统II、多器官功能障碍评分、序贯器官衰竭评估和简化急性生理学评分II等多器官功能衰竭量表是ICU治疗早期可靠的预后工具。
