Miani S, Giorgetti P L, Giordanengo F, Tealdi D
Institute of General and Cardiovascular Surgery, University of Milan, Italy.
Panminerva Med. 1998 Dec;40(4):309-13.
In spite of the progress in diagnosis and treatment of ruptured abdominal aortic aneurysms (RAAA) the mortality rate still remains very high (varying from 15% to 50% according to various experiences). This study is aimed at analyzing the relative contribution of preoperative hemodynamic conditions and of operative and postoperative factors to outcome of patients operated on for ruptured abdominal aortic aneurysms.
For this purpose a retrospective case series involving 152 patients operated on in emergency for RAAA, during the period 1990-1994, has been reviewed. In this group we examined the site of rupture, the size of the aneurysms, the presence or not of a shock condition at admission, the existence of inflammatory aspects, the adopted type of prosthesis.
The mortality rate was 24.3% (37 patients). In 10 patients (27%) the cause of death was an irreversible hemorrhagic shock. Eight patients (21.6%) died for an intestinal infarction. In 7 patients the fatal outcome was due to the development of an acute renal failure. Five patients (13.5%) underwent an acute myocardial infarction and other five a multiorgan failure. Two patients (5.5%) eventually died for respiratory insufficiency.
The results of our study seem to confirm that the outcome of patients affected by rupture of abdominal aortic aneurysms depends not only on the preoperative hemodynamic condition but also on the expertise of the surgical team.
尽管在破裂性腹主动脉瘤（RAAA）的诊断和治疗方面取得了进展，但死亡率仍然很高（根据不同经验，死亡率在15%至50%之间）。本研究旨在分析术前血流动力学状况以及手术和术后因素对接受破裂性腹主动脉瘤手术患者预后的相对影响。
为此，回顾了1990年至1994年期间152例因RAAA接受急诊手术的患者的回顾性病例系列。在该组中，我们检查了破裂部位、动脉瘤大小、入院时是否存在休克状态、炎症情况以及所采用的假体类型。
死亡率为24.3%（37例患者）。10例患者（27%）死于不可逆性失血性休克。8例患者（21.6%）死于肠梗死。7例患者的死亡是由于急性肾衰竭的发生。5例患者（13.5%）发生急性心肌梗死，另外5例发生多器官功能衰竭。2例患者（5.5%）最终死于呼吸功能不全。
我们的研究结果似乎证实，腹主动脉瘤破裂患者的预后不仅取决于术前血流动力学状况，还取决于手术团队的专业技能。
