Furukawa Hiroshi, Yamane Naoki, Honda Takeshi, Yamasawa Takahiko, Kanaoka Yuji, Tanemoto Kazuo
Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
Gen Thorac Cardiovasc Surg. 2019 Feb;67(2):208-213. doi: 10.1007/s11748-018-0994-y. Epub 2018 Aug 22.
We retrospectively assessed the initial clinical role of preoperative frailty in surgical patients with Stanford type A acute aortic dissection (AAAD).
One hundred and fourteen consecutive patients who underwent emergent or urgent surgical interventions for AAAD in our institute between April 2000 and March 2016 participated in this retrospective study. Patients with more than three of the following six modalities were defined as being frail: age older than 75 years, preoperative requirement of assistance in daily living, body mass index less than 18.5 kg/m, female, history of major stroke, and chronic kidney disease greater than class 3b. Twenty-three patients (20.2%) were diagnosed with frailty (group F), while 91 patients (79.8%) were not (group N). Early clinical outcomes, major postoperative complications, postoperative recovery of activity, and early or mid-term survival were evaluated.
Although early clinical outcomes and the prevalence of major postoperative complications were similar in both groups, postoperative activity of daily living (ADL), such as the rate of being ambulatory on discharge (p < 0.05) and home discharge (p < 0.01), was significantly lower in group F than in group N. A Kaplan-Meier analysis revealed that 1- and 5-year survival rates were similar in groups F (85.9 and 76.4%, respectively) and N (86.0 and 76.9%, respectively).
Preoperative frailty in AAAD surgical patients has potential as a prognostic factor that affects delays in ADL recovery, but does not influence the early or mid-term clinical outcomes of prompt surgical strategies for life rescue in AAAD patients with frailty.
我们回顾性评估了术前衰弱在斯坦福A型急性主动脉夹层（AAAD）手术患者中的初始临床作用。
2000年4月至2016年3月期间，在我们研究所接受急诊或紧急手术干预治疗AAAD的114例连续患者参与了这项回顾性研究。以下六种情况中出现三种以上的患者被定义为衰弱：年龄大于75岁、术前需要日常生活协助、体重指数小于18.5kg/m²、女性、有重大中风病史以及慢性肾病3b级以上。23例患者（20.2%）被诊断为衰弱（F组），而91例患者（79.8%）未被诊断为衰弱（N组）。评估了早期临床结果、主要术后并发症、术后活动恢复情况以及早期或中期生存率。
尽管两组的早期临床结果和主要术后并发症发生率相似，但F组术后日常生活活动（ADL），如出院时行走率（p<0.05）和出院回家率（p<0.01）明显低于N组。Kaplan-Meier分析显示，F组（分别为85.9%和76.4%）和N组（分别为86.0%和76.9%）的1年和5年生存率相似。
AAAD手术患者术前衰弱有可能作为一种预后因素，影响ADL恢复延迟，但不影响对衰弱的AAAD患者进行挽救生命的及时手术策略的早期或中期临床结果。
