Akins C W, Buckley M J, Daggett W, McIlduff J B, Austen W G
Ann Thorac Surg. 1981 Apr;31(4):305-9. doi: 10.1016/s0003-4975(10)60955-1.
During a ten-year period, 44 patients were treated for acute traumatic disruption of the thoracic aorta. Of the 44 patients, 21 had operative repair within 48 hours of injury (Group 1); 14 patients had operative therapy electively delayed for 2 to 79 days (Group 2); 5 had operative therapy electively delayed indefinitely (Group 3); 2 had immediate operative repair when a delayed diagnosis was made at 21 and 56 days, respectively (Group 4); 1 patient died during angiography and 1 refused operation (Group 5). Mortality was as follows: Group 1, 24%; Group 2, 14% Group 3, 0; Group 4, 100%; and Group 5, 100%. All operative deaths occurred in the subgroup of 23 patients in whom left heart bypass was utilized. Immediate operative intervention with a heparinized shunt is preferable as soon as the diagnosis of thoracic aortic disruption has been established, but elective delay of operation in patients with severe concomitant injuries can be achieved safely with beta blockade and antihypertensive therapy.
在十年期间，44例患者因胸主动脉急性创伤性破裂接受治疗。44例患者中，21例在受伤后48小时内接受了手术修复（第1组）；14例患者选择性地延迟手术治疗2至79天（第2组）；5例患者选择性地无限期延迟手术治疗（第3组）；2例分别在伤后21天和56天延迟诊断时立即接受了手术修复（第4组）；1例患者在血管造影时死亡，1例拒绝手术（第5组）。死亡率如下：第1组为24%；第2组为14%；第3组为0；第4组为100%；第5组为100%。所有手术死亡均发生在使用左心转流的23例患者亚组中。一旦确诊胸主动脉破裂，应尽快进行肝素化分流的立即手术干预，但对于伴有严重合并伤的患者，通过β受体阻滞剂和抗高血压治疗可安全地实现手术的选择性延迟。
