Hewin D F, Campbell W B
Department of Surgery, Royal Devon and Exeter Hospital, Wonford.
Ann R Coll Surg Engl. 1998 May;80(3):221-5.
Despite published criteria predicting poor survival after operation for ruptured abdominal aortic aneurysm (RAAA), little is known about the factors which influence surgeons not to operate. Questionnaires were sent to all 404 members of the Vascular Surgical Society of Great Britain and Ireland, posing questions about their practices, and factors influencing the decision not to operate (no influence; may influence; seldom operate; never operate). There were 323 responses (81%) and 97% decided not to operate on selected patients. Age over 80 years influenced 77%, and 54% seldom or never operate over age 85 years. The single most influential factor was severe neurological disease (75% seldom or never operate), while cardiac, pulmonary and renal disease influenced 22%, 28%, and 21%, respectively, to operate seldom or never (74% if two or more of these). Other factors which had some influence for most surgeons were cardiac arrest (85%), loss of consciousness (74%), prolonged hypotension (73%), and long-term nursing care (87%). By contrast, factors which influenced few surgeons were haemoglobin < 9 g/dl (30%), absence of a close relative (33%), and medicolegal considerations (22%). These data help to inform the debate about case selection for repair of RAAA.
尽管已公布的标准预测腹主动脉瘤破裂（RAAA）手术后生存率较低，但对于影响外科医生不进行手术的因素却知之甚少。我们向英国和爱尔兰血管外科学会的所有404名成员发送了问卷，询问他们的手术习惯以及影响不进行手术决策的因素（无影响；可能有影响；很少手术；从不手术）。共收到323份回复（81%），其中97%的人决定不对某些患者进行手术。80岁以上的年龄因素影响了77%的人，85岁以上的人中有54%很少或从不进行手术。最具影响力的单一因素是严重的神经系统疾病（75%很少或从不进行手术），而心脏、肺部和肾脏疾病分别影响22%、28%和21%的人很少或从不进行手术（如果其中两种或更多种疾病，则为74%）。对大多数外科医生有一定影响的其他因素包括心脏骤停（85%）、意识丧失（74%）、长时间低血压（73%）和长期护理需求（87%）。相比之下，对少数外科医生有影响的因素包括血红蛋白<9 g/dl（30%）、没有近亲（33%）和法医学考虑因素（22%）。这些数据有助于为关于RAAA修复病例选择的辩论提供参考。
