在接受急性A型大动脉解剖手术的老年患者中,阻 perfusion 模式的影响
Leonard Pitts1,2, Markus Kofler1,2,3, Matteo Montagner1,2
1Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
概括
经过急性A型大动脉解剖手术 (ATAAD) 的老年患者有多层次的输血阻塞,预后非常差. 谨慎和经验丰富的手术团队对于这个高危人群至关重要.
科学领域:
- 心血管外科心血管外科
- 胸部外科手术 胸部外科手术
- 大动脉疾病 大动脉疾病
背景情况:
- 急性甲动脉解剖A型 (ATAAD) 是一种危及生命的疾病,需要迅速的手术干预.
- 老年患者代表着越来越多的接受ATAAD手术的人口,经常有复杂的并发症.
- ATAAD的一个并发症 - - 输出不良 - - 显著影响手术结果.
研究的目的:
- 为了研究老年患者 (≥70岁) 患有ATAAD的外科治疗结果.
- 通过宾夕法尼亚分类来分层分析紫外线对短期和长期结果的影响.
- 在这个患者队列中确定1年死亡率的独立风险因素.
主要方法:
- 对400名老年患者进行回顾性分析,这些患者接受了ATAAD (2000-2020年) 的手术治疗.
- 根据Penn分类,分层分为四个组:Penn Aa (没有 malperfusion),Penn Ab (局部化),Penn Ac (系统性) 和Penn Abc (多级别 malperfusion).
- 多变量二进制物流回归来确定1年死亡率的风险因素.
主要成果:
- 多级 malperfusion (Penn Abc) 与70%的住院死亡率有关.
- 年龄和多层输血是1年死亡率的独立风险因素.
- 没有 malperfusion (Penn Aa) 的患者在医院内死亡率为13%,而多级 malperfusion 的患者的1年生存率最差.
结论:
- 在老年患者中,手术可以在没有输血的情况下获得令人满意的结果.
- 患有多级 malperfusion 的老年患者手术结果非常差,需要谨慎的手术决策.
- 对于老年人多层次输血的ATAAD的外科手术应由经验丰富的外科手术团队进行.
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