影响患者长期死亡率的术前因素从存活到破裂腹腔大动脉瘤修复的患者
Nicola Troisi1, Giacomo Isernia2, Giulia Bertagna3
1Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy - nicola.troisi@unipi.it.
概括
破裂腹腔大动脉动脉瘤 (rAAA) 修复后的长期存活率不受治疗类型 (EVAR与OSR) 的影响. 女性性别,80岁以上的年龄和COPD是幸存者晚期死亡的独立预测因素.
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.
- 确定影响rAAA修复后长期生存的因素对于患者管理至关重要.
- 以前的研究集中在短期结果上,不太重视幸存者的长期死亡预测因素.
研究的目的:
- 追溯分析与经过手术修复rAAA的患者的长期死亡相关的术前因素.
- 在rAAA患者中,比较血管内主动脉修复 (EVAR) 和开放外科修复 (OSR) 之间的长期存活率.
- 确定在最初的90天术后期幸存下来的患者中晚期死亡的独立预测因素.
主要方法:
- 通过计算机断层扫描诊断出rAAA的405名患者的回顾性分析,在2007年至2021年期间接受治疗.
- 对30日和90日死亡率的评估.
- 卡普兰-梅尔分析估计的10年生存期在90天以上的患者中.
- 单变量和多变量考克斯回归分析,以确定10年生存的手术前预测因素.
主要成果:
- 在405名患者中,94人 (23.3%) 患有EVAR,311人 (76.8%) 患有OSR. 30天死亡率为24.2%,而出血性休克作为一个独立的预测因素.
- 90天的死亡率为32.6%. 幸存者的估计10年生存率为33.3%.
- 治疗类型 (EVAR与OSR) 并没有显著影响长期免于AAA相关死亡. 女性性别,80岁以上的年龄和COPD独立地与幸存者的晚期死亡率增加有关.
结论:
- 治疗方式 (EVAR或OSR) 在急需修复rAAA后不会影响长期存活率.
- 在幸存rAAA修复的患者中,晚年 (>80岁),女性性别和慢性阻塞性肺病是长期生存的显著负面预测因素.
- 术前风险分层应考虑这些因素,以优化术后护理和rAAA幸存者的长期管理策略.
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