Chen J C, Hildebrand H D, Salvian A J, Taylor D C, Strandberg S, Myckatyn T M, Hsiang Y N
Department of Surgery, Vancouver Hospital, University of British Columbia, Canada.
J Vasc Surg. 1996 Oct;24(4):614-20; discussion 621-3. doi: 10.1016/s0741-5214(96)70077-0.
This study evaluated perioperative variables to predict death in nonruptured and ruptured abdominal aortic aneurysm (AAA) surgery.
A consecutive review of all patients who underwent AAA surgery from January 1984 to December 1993 was carried out. Perioperative variables were analyzed with univariate and multivariate statistical models to predict mortality rates.
Four hundred seventy-eight patients with nonruptured AAAs and 157 patients with ruptured AAAs were studied. In patients with nonruptured AAAs, the mortality rate was 3.8%. Using stepwise logistic regression analysis, independent predictors of death were perioperative myocardial infarction (odds ratio [OR], 5.0; p < 0.01), prolonged postoperative ventilation (OR, 4.0; p < 0.01), history of peripheral vascular disease (OR, 2.9; p < 0.01), preoperative renal dysfunction (OR, 2.7; p < 0.01), and history of congestive heart failure (OR, 2.6; p < 0.03). In patients with ruptured AAAs, the mortality rate was 46%. Analysis of preoperative variables using multivariate stepwise logistic regression found predictors of death to be preoperative unconsciousness (OR, 3.1; p < 0.01), advanced age (OR, 1.9; p < 0.01), and cardiac arrest (OR, 1.8; p < 0.05). In patients who survived the initial surgery for ruptured AAA, a second stepwise logistic regression model found independent predictors for subsequent postoperative death to be coagulation disorder (OR, 7.9; p < 0.01), ischemic colitis (OR, 6.4; p < 0.01), inotropic support beyond 48 hours (OR, 4.8; p < 0.01), delayed transport to operating room (OR, 4.6; p < 0.01), advanced age (OR, 4.4; p < 0.01), perioperative myocardial infarction (OR, 4.0; p < 0.05) and postoperative renal dysfunction (OR, 3.7; p < 0.01).
Prolonged ventilation, perioperative myocardial infarction, a history of peripheral vascular disease, preoperative renal dysfunction, and a history of congestive heart failure are independent predictors of perioperative death in patients with nonruptured AAAs. For patients with ruptured AAAs, mortality rates can be estimated before surgery using age, level of consciousness, and cardiac arrest. For patients who survive the initial surgery for ruptured AAA, subsequent mortality rates can also be predicted.
本研究评估围手术期变量以预测非破裂性和破裂性腹主动脉瘤（AAA）手术中的死亡情况。
对1984年1月至1993年12月期间接受AAA手术的所有患者进行连续回顾。使用单变量和多变量统计模型分析围手术期变量以预测死亡率。
研究了478例非破裂性AAA患者和157例破裂性AAA患者。在非破裂性AAA患者中，死亡率为3.8%。使用逐步逻辑回归分析，死亡的独立预测因素为围手术期心肌梗死（优势比[OR]，5.0；p<0.01）、术后通气时间延长（OR，4.0；p<0.01）、外周血管疾病史（OR，2.9；p<0.01）、术前肾功能不全（OR，2.7；p<0.01）和充血性心力衰竭史（OR，2.6；p<0.03）。在破裂性AAA患者中，死亡率为46%。使用多变量逐步逻辑回归分析术前变量发现，死亡的预测因素为术前意识不清（OR，3.1；p<0.01）、高龄（OR，1.9；p<0.01）和心脏骤停（OR，1.8；p<0.05）。在破裂性AAA初次手术后存活的患者中，第二个逐步逻辑回归模型发现，后续术后死亡的独立预测因素为凝血障碍（OR，7.9；p<0.01）、缺血性结肠炎（OR，6.4；p<0.01）、48小时以上的血管活性药物支持（OR，4.8；p<0.01）、延迟转运至手术室（OR，4.6；p<0.01）、高龄（OR，4.4；p<0.01）、围手术期心肌梗死（OR，4.0；p<0.05）和术后肾功能不全（OR，3.7；p<0.01）。
通气时间延长、围手术期心肌梗死、外周血管疾病史、术前肾功能不全和充血性心力衰竭史是非破裂性AAA患者围手术期死亡的独立预测因素。对于破裂性AAA患者，术前可使用年龄、意识水平和心脏骤停来估计死亡率。对于破裂性AAA初次手术后存活的患者，也可预测其后续死亡率。
