腹主动脉瘤破裂：术中管理对手术结果的影响。

Ruptured abdominal aortic aneurysm: influence of intraoperative management on surgical outcome.

作者信息

Marty-Ané C H, Alric P, Picot M C, Picard E, Colson P, Mary H

机构信息

Service de Chirurgie Vasculaire et Thoracique, Hôpital Arnaud de Villeneuve, Montpellier, France.

出版信息

J Vasc Surg. 1995 Dec;22(6):780-6. doi: 10.1016/s0741-5214(95)70069-2.

DOI:10.1016/s0741-5214(95)70069-2

PMID:8523613

Abstract

PURPOSE

This study was designed to determine the influence of changes in intraoperative management on the outcome of ruptured abdominal aortic aneurysm (RAAA).

METHODS

Retrospective review of our surgical experience of RAAA identified 61 patients and was separated into two periods: 1986 to 1988 (group 1 [n = 21 patients]) and 1989 to 1994 (group 2 [n = 40 patients]). Since 1989 operations have been conducted by two vascular surgeons without systemic administration of heparin and with control of suprarenal aorta if extensive hematoma is present, use of collagen-impregnated grafts, preferential repair with aortoaortic grafting, and routine use of intraoperative autotransfusion.

RESULTS

Factors differing between the groups were use of intraoperative autotransfusion (4.76% in group 1 vs 80% in group 2, p < 0.00001), repair with tube grafting (42.8% in group 1 vs 80% in group 2, p = 0.003), number of packed homologous red blood cells (7.5 +/- 5.2 units in group 1 vs 3.1 +/- 3.6 units in group 2, p = 0.008), postoperative blood loss (365 +/- 705 ml in group 1 vs 133 +/- 351 ml in group 2, p = 0.01). The intraoperative mortality rate was significantly lower in group 2 (5% vs 28.6%, p = 0.016). The only predictive factor was the use of intraoperative autotransfusion with a lower mortality rate in patients undergoing autotransfusion (p = 0.029). The postoperative mortality rate was significantly lower in group 2 (20% vs 52.4%, p = 0.009). Predictive factors were use of intraoperative autotransfusion (p = 0.0009), age of the patients (p = 0.0039), and repair with tube graft (p = 0.039). The odds ratio of postoperative death was 25 times higher without intraoperative autotransfusion and seven times lower when a tube graft was used.

CONCLUSION

Continuing efforts to achieve improvement in surgical technique and use of intraoperative autotransfusion were important determinants in lowering the postoperative mortality rate of RAAA to 20%.

摘要

目的

本研究旨在确定术中管理的变化对破裂腹主动脉瘤（RAAA）手术结果的影响。

方法

回顾性分析我们的RAAA手术经验，确定了61例患者，并分为两个时期：1986年至1988年（第1组[n = 21例患者]）和1989年至1994年（第2组[n = 40例患者]）。自1989年以来，手术由两名血管外科医生进行，不全身应用肝素，如有广泛血肿则控制肾上主动脉，使用胶原浸渍移植物，优先采用主动脉-主动脉移植修复，并常规使用术中自体输血。

结果

两组之间不同的因素包括术中自体输血的使用情况（第1组为4.76%，第2组为80%，p < 0.00001）、人工血管移植修复（第1组为42.8%，第2组为80%，p = 0.003）、浓缩同型红细胞输注量（第1组为7.5±5.2单位，第2组为3.1±3.6单位，p = 0.008）、术后失血量（第1组为365±705 ml，第2组为133±351 ml，p = 0.01）。第2组的术中死亡率显著较低（5%对28.6%，p = 0.016）。唯一的预测因素是术中自体输血的使用，接受自体输血的患者死亡率较低（p = 0.029）。第2组的术后死亡率显著较低（20%对52.4%，p = 0.009）。预测因素包括术中自体输血的使用（p = 0.0009）、患者年龄（p = 0.0039）和人工血管移植修复（p = 0.039）。未进行术中自体输血时术后死亡的优势比高25倍，使用人工血管移植时低7倍。