Martin R S, Edwards W H, Jenkins J M, Edwards W H, Mulherin J L
Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Am Surg. 1988 Sep;54(9):539-43.
An 8-year experience with treatment of 58 patients with ruptured abdominal aortic aneurysm (RAAA) is reviewed with hospital mortality of 25.9 per cent. Added to a previously reported experience, 115 patients have been treated over 25 years with 33 per cent mortality. Preoperative hypotension, free rupture, venous injury, and massive transfusion were found to be associated with mortality. Interhospital transfer, preexisting coronary or pulmonary disease, known aneurysm, anemia, delay in surgery, and operative time were not found to predict outcome. Some patients are normotensive at presentation, providing an excellent chance for survival when expeditious diagnosis and treatment are carried out. Optimal operative management, complications, and causes of death are discussed. The role of computed tomography (CT) in diagnosis is considered. Elective resection of known aneurysms is the most important factor in reducing deaths from RAAA. The role of regionalization of care is unclear, since some patients cannot be safely transported. However, some evidence for optimal results in specialized centers is presented.
回顾了对58例腹主动脉瘤破裂（RAAA）患者进行治疗的8年经验，医院死亡率为25.9%。加上先前报道的经验，25年来共治疗了115例患者，死亡率为33%。发现术前低血压、游离破裂、静脉损伤和大量输血与死亡率相关。未发现院际转运、既往存在的冠状动脉或肺部疾病、已知动脉瘤、贫血、手术延迟和手术时间可预测预后。一些患者就诊时血压正常，若能迅速诊断并治疗，生存机会很大。讨论了最佳手术管理、并发症和死亡原因。考虑了计算机断层扫描（CT）在诊断中的作用。对已知动脉瘤进行择期切除是降低RAAA死亡的最重要因素。护理区域化的作用尚不清楚，因为一些患者无法安全转运。然而，文中提供了一些在专科中心取得最佳效果的证据。
