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开放第一的策略是可以接受的腹腔大动脉动脉瘤破裂,即使在内血管时代是可以接受的

Yoshimasa Seike¹, Koki Yokawa¹, Shigeki Koizumi¹

¹Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan.

|June 2, 2023

概括

开放式手术修复是破裂腹腔大动脉动脉瘤 (RAAA) 的可接受一线策略. 不良的手术前条件,而不是手术,预测RAAA患者的住院死亡率.

科学领域:

血管外科血管外科
大动脉动脉瘤研究研究
手术结果分析手术结果分析

背景情况:

破裂的腹腔大动脉动脉瘤 (RAAA) 是一个关键的手术紧急情况.
对于RAAA的最佳管理策略,平衡开放式外科修复 (OSR) 和内血管动脉瘤修复 (EVAR),仍然是一个研究领域.
了解死亡率预测因素对于改善患者的治疗结果至关重要.

研究的目的:

在过去的十年中,使用开放式策略评估RAAA的外科发现.
在当前的内血管时代,确定RAAA患者住院死亡率的预测因素.

主要方法:

对116名接受RAAA修复的患者的回顾性分析.
血管内动脉瘤修复 (EVAR) 和开放式手术修复 (OSR) 组之间的结果比较.
单变量分析以确定死亡率预测因素.

主要成果:

在86.2%的患者中进行了开放式手术修复 (OSR),而在13.8%的患者中使用了EVAR.
住院死亡率的预测因素包括手术前心肺骤停 (CPA),高冲击指数,低基数过剩 (BE),乳酸 (Lac) 和血糖 (BS) >215 mg/dL.
发现基数过剩 (BE) 是一个显著的负预测因素 (OR 0.88;p=0.006).

结论:

对于RAAA而言,开放第一的策略是一个可行的方法.
手术前的患者状况,而不是手术技术,与住院死亡率密切相关.
死亡率的主要预测因素包括CPA,冲击指数,BE,Lac和BS水平,突出显示了手术前生理状态的重要性.

关键词:

血管内动脉瘤修复血管内动脉瘤修复开放的外科修复.风险因素风险因素风险因素破裂的腹腔大动脉动脉瘤.

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