Browning N G, Long M A, Barry R, Nel C J, Schall R, Monk E
Department of Surgery, University of the Orange Free State, Bloemfontein.
S Afr J Surg. 1995 Mar;33(1):21-5.
Although elective abdominal aortic aneurysm (AAA) repair can be done with a less than 5% mortality rate, ruptured AAAs have a 32-85% mortality rate. The aims of this study were: (i) to identify prognostic factors affecting mortality; (ii) to identify and assess the impact of postoperative complications on mortality; and (iii) to try to identify a subgroup of patients who would not benefit from surgery. The records of 54 patients presenting with ruptured AAAs were reviewed; 49 of these patients were operated on, 43 of them males and 6 females (mean age 67 years). The operative mortality rate was 44%, most patients who died doing so in the intensive care unit. In 14 cases AAA was diagnosed before rupture--6 of these patients died. Factors that had a significant effect on mortality were: (i) associated ischaemic heart disease--83% of these patients died postoperatively; (ii) the degree of shock on admission--66% of patients with a blood pressure on admission of 85 mmHg or less died; and (iii) the number of postoperative complications per patients--those with 2 or more complications had an 83% mortality rate. Factors that did not correlate statistically with mortality were age, time interval to surgery, volume and composition of intra-operative fluid therapy, and length of surgery. The most important correctable error was failure to operate electively. From the factors assessed it was not possible clearly to identify a subgroup of patients in this study who should have been excluded from surgery.
尽管择期性腹主动脉瘤（AAA）修复手术的死亡率可低于5%，但破裂性AAA的死亡率却高达32% - 85%。本研究的目的是：（i）确定影响死亡率的预后因素；（ii）确定并评估术后并发症对死亡率的影响；（iii）试图找出一组无法从手术中获益的患者亚组。对54例破裂性AAA患者的记录进行了回顾；其中49例患者接受了手术，男性43例，女性6例（平均年龄67岁）。手术死亡率为44%，大多数死亡患者发生在重症监护病房。14例AAA在破裂前被诊断出来，其中6例患者死亡。对死亡率有显著影响的因素包括：（i）合并缺血性心脏病——这些患者中有83%术后死亡；（ii）入院时的休克程度——入院时血压在85 mmHg及以下的患者中有66%死亡；（iii）每位患者术后并发症的数量——有2种或更多并发症的患者死亡率为83%。与死亡率无统计学相关性的因素包括年龄、至手术的时间间隔、术中液体治疗的量和成分以及手术时长。最重要的可纠正失误是未进行择期手术。从所评估的因素来看，本研究中无法明确识别出一组本应被排除在手术之外的患者亚组。
