急性A型主动脉夹层急诊手术后的长期预后和生活质量：青年与老年成年人的比较
Long-term outcome and quality of life following emergency surgery for acute aortic dissection type A: a comparison between young and elderly adults.
作者信息
Jussli-Melchers Jill, Panholzer Bernd, Friedrich Christine, Broch Ole, Renner Jochen, Schöttler Jan, Rahimi Aziz, Cremer Jochen, Schoeneich Felix, Haneya Assad
机构信息
Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Department of Anesthesiology and Intensive Care Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
出版信息
Eur J Cardiothorac Surg. 2017 Mar 1;51(3):465-471. doi: 10.1093/ejcts/ezw408.
OBJECTIVES
Innovations in surgical techniques and perioperative management have continuously improved survival rates for acute aortic dissection type A (AADA). The aim of our study was to evaluate long-term outcome and quality of life (QoL) after surgery for AADA in elderly patients compared with younger patients.
METHODS
We retrospectively evaluated 242 consecutive patients, who underwent surgery for AADA between January 2004 and April 2014. Patients were divided into two groups: those aged 70 years and older (elderly group; n = 78, mean age, 76 ± 4 years) and those younger than 70 years (younger group; n = 164, mean age, 56 ± 10 years). QoL was assessed with the Short Form Health Survey Questionnaire (SF-36) 1 year after surgery.
RESULTS
The questionnaire return rate was 91.0%. There were already significant differences noted between the two groups with regard to preoperative risk factors on admission. The clinical presentation with a cardiac tamponade was higher in the elderly group (62.8% vs 47.6%; P = 0.03). Intraoperatively, complex procedures were more common in the younger group (21.3% vs 5.2%; P = 0.001). Accordingly, cardiopulmonary bypass and cross-clamping times were significantly longer in the younger group. The operative mortality was similar in both groups (3.8% vs 1.2%; P = 0.33). In the elderly population, 30-day mortality was higher (21.8% vs 7.9%; P = 0.003). One-year (72% vs 85%), 3-year (68% vs 84%) and 5-year (63% vs 79%) survival rates were satisfactory for the elderly group, but significantly lower compared with the younger group ( P = 0.008). The physical component summary score also was similar between the groups (39.14 ± 11.12 vs 39.12 ± 12.02; P = 0.99). However, the mental component summary score might be slightly higher in the elderly group but not statistically significant (51.61 ± 10.73 vs 48.63 ± 11.25; P = 0.12).
CONCLUSIONS
Satisfactory long-term outcome and the general perception of well-being encourage surgery in selected elderly patients with AADA.
目的
手术技术和围手术期管理的创新不断提高了急性A型主动脉夹层（AADA）的生存率。我们研究的目的是评估老年患者与年轻患者AADA手术后的长期结局和生活质量（QoL）。
方法
我们回顾性评估了2004年1月至2014年4月期间连续接受AADA手术的242例患者。患者分为两组：70岁及以上的患者（老年组；n = 78，平均年龄76±4岁）和70岁以下的患者（年轻组；n = 164，平均年龄56±10岁）。术后1年采用简短健康调查问卷（SF-36）评估生活质量。
结果
问卷回收率为91.0%。两组入院时的术前危险因素已经存在显著差异。老年组心脏压塞的临床表现更高（62.8%对47.6%；P = 0.03）。术中，复杂手术在年轻组中更常见（21.3%对5.2%；P = 0.001）。因此，年轻组的体外循环和主动脉阻断时间明显更长。两组的手术死亡率相似（3.8%对1.2%；P = 0.33）。在老年人群中，30天死亡率更高（21.8%对7.9%；P = 0.003）。老年组的1年（72%对85%）、3年（68%对84%）和5年（63%对79%）生存率令人满意，但与年轻组相比显著较低（P = 0.008）。两组的身体成分总结得分也相似（39.14±11.12对39.12±12.02；P = 0.99）。然而，老年组的心理成分总结得分可能略高，但无统计学意义（51.61±10.73对48.63±11.25；P = 0.12）。
结论
令人满意的长期结局和总体幸福感促使对部分老年AADA患者进行手术。
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