Omura Atsushi, Nakai Hidekazu, Minami Hitoshi, Ishigaki Takahiro, Koda Yojiro, Tateishi Naoki, Tani Kazuhiro, Henmi Soichiro, Murakami Hirohisa, Honda Tasuku, Matsuda Hitoshi, Yoshida Masato, Mukohara Nobuhiko
Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Japan.
Kyobu Geka. 2016 Apr;69(4):304-9.
The purpose of this study was to evaluate early and long term outcomes of surgery for acute type A aortic dissection complicated with organ malperfusion.
From January 2001 to October 2015, 336 consecutive patients (mean age 68.6±12.2, male 172) underwent surgery for acute type A aortic dissection at out center. Early and late outcomes were compared between patients accompanied with and without organ malperfusion.
Preoperative organ malperfusion was observed in 76 patients( 22.6%). That consisted of 38 neurological systems, 13 coronary, 8 visceral, and 26 extremities. Nine patients had 2 organ malperfusion. In-hospital mortality was 22.4% and 6.5% in patients with and without organ malperfusion, respectively. Multivariate logistic analysis showed preoperative organ malperfusion was a significant risk factor for in-hospital mortality (Odds ratio 3.59, 95% confidence interval 1.56~8.28, p<0.01). Five year survival rate of hospital survivors were 84.5±5.5% and 80.9±3.3% with and without organ malperfusion (p=0.51).
Although organ malperfusion is still associated with high mortality, however, acceptable long term outcomes could be obtained if organ malperfusion is treated appropriately. Ischemic organ oriented approach might be very important to improve surgical outcomes of these critically ill conditions.
本研究旨在评估急性A型主动脉夹层合并器官灌注不良手术的早期和长期结果。
2001年1月至2015年10月，连续336例患者（平均年龄68.6±12.2岁，男性172例）在我院接受急性A型主动脉夹层手术。比较伴有和不伴有器官灌注不良患者的早期和晚期结果。
76例患者（22.6%）术前存在器官灌注不良。其中38例为神经系统、13例为冠状动脉、8例为内脏、26例为肢体。9例患者存在2种器官灌注不良。伴有和不伴有器官灌注不良患者的院内死亡率分别为22.4%和6.5%。多因素logistic分析显示，术前器官灌注不良是院内死亡的重要危险因素（优势比3.59，95%可信区间1.56~8.28，p<0.01）。伴有和不伴有器官灌注不良的住院幸存者5年生存率分别为84.5±5.5%和80.9±3.3%（p=0.51）。
尽管器官灌注不良仍与高死亡率相关，但如果得到适当治疗，仍可获得可接受的长期结果。以缺血器官为导向的方法可能对改善这些危重症患者的手术结果非常重要。
