Svensson L G, Crawford E S, Hess K R, Coselli J S, Safi H J
Department of Surgery, Baylor College of Medicine, Houston, TX.
J Vasc Surg. 1993 Feb;17(2):357-68; discussion 368-70.
The purpose of this study was to retrospectively identify variables associated with early death and postoperative complications in patients undergoing thoracoabdominal aortic operations.
The data on 1509 patients who underwent 1679 thoracoabdominal aortic repairs between 1960 and 1991 were retrospectively reviewed. The median age was 66 years (range 1.5 years to 86 years), and aortic dissection was present in 276 (18%) patients. The extent of the first repair performed included 378 (25%) type I (proximal descending to upper abdominal aorta), 442 (29%) type II (proximal descending aorta to below the renal arteries), 343 (23%) type III (distal descending and abdominal aorta), and 346 (23%) type IV (most of the abdominal aorta). The median total aortic clamp time was 43 minutes.
The 30-day survival rate was 92% (1386/1509) for the 30-year period. On multivariate analysis the preoperative and operative variables associated with death included (p < 0.05) increasing age, preoperative creatinine level, concurrent proximal aortic aneurysms, coronary artery disease, chronic lung disease, and total aortic clamp time. When the postoperative variables were also included in the stepwise logistic regression model, then in addition, cardiac complications, stroke, kidney failure, and gastrointestinal hemorrhage became significant (p < 0.05). The overall incidence of paraplegia or paraparesis was 16% (234/1509). By use of stepwise logistic regression analysis, the significant predictors (p < 0.05) of paraplegia or paraparesis developing were total aortic clamp time, extent of aorta repaired, aortic rupture, patient age, proximal aortic aneurysm, and history of renal dysfunction. Kidney failure (postoperative creatinine level > 3 mg/dl or dialysis) occurred in 18% (269/1509) of patients; dialysis was required in 9% (136/1509). Gastrointestinal complications manifested in 7% (101/1509) of patients.
Although the survival rate has improved, paraplegia/paraparesis and kidney failure continue to be vexing problems that require further research.
本研究的目的是回顾性确定与胸腹主动脉手术患者早期死亡和术后并发症相关的变量。
回顾性分析了1960年至1991年间1509例接受1679次胸腹主动脉修复手术患者的数据。中位年龄为66岁（范围1.5岁至86岁），276例（18%）患者存在主动脉夹层。首次修复的范围包括378例（25%）I型（近端降主动脉至腹主动脉上段）、442例（29%）II型（近端降主动脉至肾动脉以下）、343例（23%）III型（远端降主动脉和腹主动脉）和346例（23%）IV型（大部分腹主动脉）。中位总主动脉阻断时间为43分钟。
30年期间30天生存率为92%（1386/1509）。多因素分析显示，与死亡相关的术前和手术变量包括（p<0.05）年龄增加、术前肌酐水平、同时存在的近端主动脉瘤、冠状动脉疾病、慢性肺病和总主动脉阻断时间。当术后变量也纳入逐步逻辑回归模型时，此外，心脏并发症、中风、肾衰竭和胃肠道出血也具有显著性（p<0.05）。截瘫或轻瘫的总体发生率为16%（234/1509）。通过逐步逻辑回归分析，截瘫或轻瘫发生的显著预测因素（p<0.05）为总主动脉阻断时间、主动脉修复范围、主动脉破裂、患者年龄、近端主动脉瘤和肾功能不全病史。18%（269/1509）的患者发生肾衰竭（术后肌酐水平>3mg/dl或透析）；9%（136/1509）的患者需要透析。7%（101/1509）的患者出现胃肠道并发症。
尽管生存率有所提高，但截瘫/轻瘫和肾衰竭仍然是需要进一步研究的棘手问题。
