专题研究(Monographic Study)

破裂性腹主动脉瘤的急救及围手术期危险因素:附27例报告

Published at: 2016年第25卷第6期

戚悠飞 1,2 , 肖占祥 2 , 曾昭凡 2 , 岳劼 2 , 刘飒华 2 , 陈浩 2 , 张文波 2
1 中南大学湘雅二医院 血管外科,湖南 长沙 410011
2 海南省人民医院 血管外科,海南 海口 570311
通讯作者 悠飞 戚 Email: qiyoufei@aliyun.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2016.06.006
基金:
海南省自然科学基金资助项目 813205
海南省社会发展科技专项基金资助项目 2015SF04

摘要

目的:探讨破裂性腹主动脉瘤(rAAA)的急救经验及围手术期危险因素。方法:回顾性分析2007年1月—2015年9月间救治的27例rAAA患者的临床资料,其中男20例,女7例;中位年龄72岁;18例行开腹手术,6例腔内治疗(包括1例行杂交手术)。总结诊治过程、围术期情况及随访结果,并分析影响预后的因素。结果:术前死亡3例,术中死亡1例,术后死亡9例,术后死因有急性肾衰、急性呼衰、腹腔间隔室综合征、心肌梗塞、消化道出血,最终均出现多器官功能衰竭。总体抢救成功率为51.9%(14/27),开腹手术和腔内治疗成功率分别为50.0%(9/18)和83.3%(5/6)。围术期存活和死亡患者间的临床参数比较显示,发病到就诊时间、术前收缩压、术前肌酐、术中出血量及输血量、术中尿量的差异有统计学意义(均P<0.05)。结论:rAAA病情危重,病死率高,尽早确诊后应紧急外科治疗控制出血,加强围术期管理。在rAAA的救治中,腔内治疗是一种有效的治疗手段。


Emergency treatment for ruptured abdominal aortic aneurysm and perioperative risk factors: a report of 27 cases

Abstract

Objective: To review the experience in emergency treatment of ruptured abdominal aortic aneurysm (rAAA) and explore the perioperative risk factors. Methods: The clinical data of 27 patients with rAAA admitted from January 2007 to September 2015 were reviewed. Of the patients, 20 cases were male, and 7 cases were female, with a median age of 72 years; 18 cases underwent open surgery and 6 cases had endovascular repair (including one case of hybrid surgery). The diagnosis and treatment procedures, perioperative conditions and postoperative follow-up results were summarized, and the perioperative risk factors were also analyzed.Results: Pre-, intra- and postoperative death occurred in 3, 1 and 9 cases respectively. The causes for postoperative death included acute renal failure, acute respiratory failure, abdominal compartment syndrome, myocardial infarction and hemorrhage of digestive tract, all which finally led to multiple organ dysfunction syndrome. The overall successful salvage rate was 51.9% (14/27), which in open surgery was 50% (9/18) and in endovascular repair was 83.3% (5/6), respectively. Comparison of the clinical variables between patients who survived and those who died during the perioperative period showed that there was significant difference in time from onset to admission, preoperative systolic blood pressure, preoperative serum creatinine concentration, intraoperative blood loss, volume of transfusion and intraoperative urine output (all P<0.05). Conclusion: As rAAA is a lethal condition with high mortality, definitive diagnosis should be made as soon as possible to ensure emergent surgical repair to control the hemorrhage, and enhanced perioperative management is equally important. Endovascular repair is an effective approach for emergency treatment of rAAA.


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引用

引用本文: 悠飞 戚, 占祥 肖, 昭凡 曾, 劼 岳, 飒华 刘, 浩 陈, 文波 张. 破裂性腹主动脉瘤的急救及围手术期危险因素:附27例报告[J]. 中国普通外科杂志, 2016, 25(6): 814-822.
Cite this article as: QI Youfei, XIAO Zhanxiang, ZENG Zhaofan, YUE Jie, LIU Sahua, CHEN Hao, ZHANG Wenbo . Emergency treatment for ruptured abdominal aortic aneurysm and perioperative risk factors: a report of 27 cases[J]. Chin J Gen Surg, 2016, 25(6): 814-822.