Sayers R D, Thompson M M, Nasim A, Healey P, Taub N, Bell P R
Department of Surgery, Leicester Royal Infirmary, U.K.
Eur J Vasc Endovasc Surg. 1997 Mar;13(3):322-7. doi: 10.1016/s1078-5884(97)80105-0.
To audit the results for abdominal aortic aneurysm (AAA) repair from a single centre over a 13 year period.
Retrospective survey.
Vascular unit of a major teaching hospital.
Six hundred and seventy-one consecutive patients divided into two groups: group A (1981-87) and group B (1988-93).
Mortality rates, cause of death and major complications in patients undergoing elective, urgent and ruptured AAAs.
Elective repair was performed in 313 (47%) patients, urgent repair in 80 (12%) and emergency repair for rupture in 278 (41%). A vascular surgeon performed the procedure in 94% of patients. The overall mortality was 21 patients in the elective group (6.7%), 13 in the urgent group (16%) and 148 in the ruptured group (53%). Mortality rates have not fallen during the study period but more patients in group B had ischaemic heart disease. Sixty patients (9%) required further operative procedures on 66 occasions: 24 elective cases (8%), 8 urgent cases (10%) and 28 ruptured cases (10%). There were 23 deaths in these 60 patients (38%) who underwent re-operation (5 elective, 2 urgent and 16 ruptured). Major postoperative complications included cardiac events in 212 (32%) patients, respiratory failure in 202 (30%) and renal failure in 90 (13%). Major causes of death included cardiac disease in 67 patients (37%), cardiac disease with coagulopathy in 22 (12%) and cardiac disease with respiratory failure in 16 (9%). Logistic regression analysis showed that in the elective group, cardiac or renal failure were significantly associated with death; and in the ruptured group cardiac, respiratory or renal failure were significantly associated with death.
More high risk patients with ischaemic heart disease are undergoing AAA repair. Postoperative cardiac, respiratory or renal failure are significant causes of death in AAA patients.
审核一家单一中心13年间腹主动脉瘤（AAA）修复手术的结果。
回顾性调查。
一家大型教学医院的血管科。
671例连续患者分为两组：A组（1981 - 1987年）和B组（1988 - 1993年）。
择期、急诊和破裂性AAA患者的死亡率、死亡原因及主要并发症。
313例（47%）患者接受择期修复，80例（12%）接受急诊修复，278例（41%）因破裂接受紧急修复。94%的患者手术由血管外科医生完成。择期组总死亡率为21例（6.7%），急诊组为13例（16%），破裂组为148例（53%）。研究期间死亡率未下降，但B组中患缺血性心脏病的患者更多。60例（9%）患者在66次手术中需要进一步手术：24例择期病例（8%），8例急诊病例（10%），28例破裂病例（10%）。这60例接受再次手术的患者中有23例死亡（38%）（5例择期，2例急诊，16例破裂）。主要术后并发症包括212例（32%）患者发生心脏事件，202例（30%）发生呼吸衰竭，90例（13%）发生肾衰竭。主要死亡原因包括67例（37%）患者患有心脏病，22例（12%）患有心脏病合并凝血病，16例（9%）患有心脏病合并呼吸衰竭。逻辑回归分析表明，在择期组中，心脏或肾衰竭与死亡显著相关；在破裂组中，心脏、呼吸或肾衰竭与死亡显著相关。
更多患有缺血性心脏病的高危患者正在接受AAA修复手术。术后心脏、呼吸或肾衰竭是AAA患者死亡的重要原因。
