Sebesta P, Klika T, Zdrahal P, Kramar J
Department of Vascular Surgery, Hospital Na Homolce, Prague 5, Czech Republic.
J Mal Vasc. 1998 Dec;23(5):361-7.
In the years 1990 to 1997, 103 patients with RAAA were operated on at the Department of Vascular Surgery of the Hospital Na Homolce in Prague. Men outnumbered women, mean age was 70 years. The mean delay between onset of symptoms and hospital admission was 25 hours. Prior to transportation 85 patients were submitted to at least one confirmative evaluation test (CAT, ultrasound, angiography) and 33 patients to a combination of two or more herementioned examinations. Twenty-eight patients were referred via two or more hospital departments. In 71% of patients profound shock with oligoanuria and hypotension was found upon admission. Anuria/hypotension proved to occur in a significantly lower rate in later survivors compared to later non-survivors (S vs. NS = 30% vs. 92.1%, p < 0.002) and preoperative hematocrite and S-creatinine values copied the clinical trend. At surgery, persistent hypotension together with necessity of resuscitation steps as well as finding of free blood within the abdominal cavity showed up as further significant death predictors. Postoperatively, acute renal and/or multiorgan failure occurred in 36 patients and significantly prevailed in the NS vs. S group (48.3% vs. 22.5%, p < 0.03). Both early hemorrhage and myocardial infarction infavorably influenced the outcome. Seven patients (6.8%) expired during operation. The total of 63 patients died (61.2%) fifty-eight patients within the 30-day period (56.3%). Within the first five days 58.7% of all deaths occurred particularly related to hemorrhagic shock. The latter fatalities (41.3%) were caused by both organ failure and septic complications. In our cohort regardless of age, type or extent of surgery, outcome was determined by status upon admission. Delay in surgical treatment caused both by time consuming confirmative evaluation and patient's lengthy transfers is responsible for ominous protraction of the original shock. Especially in intraperitoneal rupture, the irreversible sequels of devastating hemorrhage only rarely do not lead to a fatal end albeit the patients survive the aortic reconstruction.
1990年至1997年间，布拉格纳霍姆采医院血管外科为103例破裂性腹主动脉瘤患者进行了手术。男性患者多于女性，平均年龄为70岁。症状出现至入院的平均延迟时间为25小时。转运前，85例患者接受了至少一项确诊评估检查（计算机断层扫描、超声、血管造影），33例患者接受了两项或更多上述检查的联合检查。28例患者经两个或更多医院科室转诊。71%的患者入院时出现严重休克伴少尿和低血压。与后期非幸存者相比，后期幸存者中无尿/低血压的发生率明显较低（幸存者与非幸存者分别为30%和92.1%，p<0.002），术前血细胞比容和血清肌酐值也呈现出相同的临床趋势。手术时，持续性低血压以及需要进行复苏措施，以及腹腔内发现游离血液，均显示为进一步的显著死亡预测因素。术后，36例患者发生急性肾和/或多器官功能衰竭，在非幸存者与幸存者组中显著多见（48.3%对22.5%，p<0.03）。早期出血和心肌梗死均对预后产生不利影响。7例患者（6.8%）在手术期间死亡。共有63例患者死亡（61.2%），其中58例在30天内死亡（56.3%）。在头五天内，所有死亡病例中有58.7%发生，尤其与失血性休克有关。后者的死亡（41.3%）是由器官衰竭和感染性并发症共同导致的。在我们的队列中，无论年龄、手术类型或范围如何，预后均取决于入院时的状况。耗时的确诊评估和患者的长时间转诊导致手术治疗延迟，这是原始休克不祥延长的原因。特别是在腹腔内破裂时，尽管患者在主动脉重建后存活，但毁灭性出血的不可逆后果很少不会导致致命结局。
