对急性A型大动脉剖析进行非手术治疗后的预后
Koki Yokawa1, Shigeki Koizumi1, Mio Kasai1
1Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
General thoracic and cardiovascular surgery
|February 25, 2024
概括
斯坦福A型急性大动脉剖析 (AAAD) 携带高死亡风险,特别是在不适合或拒绝手术的老年患者中. 保守的管理给那些拒绝接受手术的人带来了37%的住院死亡率,幸存者的长期生存率是可以接受的.
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
- 血管外科 血管外科
背景情况:
- 斯坦福A型急性大动脉剖析 (AAAD) 通常需要立即的手术干预才能生存.
- 老年患者或患有并发症的患者对AAAD的外科治疗提出了独特的挑战.
研究的目的:
- 评估AAAD患者的非手术治疗结果,这些患者不适合手术或拒绝手术.
- 为提供有关老年人或高风险人群AAAD治疗选择的知情决策提供数据.
主要方法:
- 分析了35名AAAD患者的队列,这些患者被认为无法接受手术或拒绝接受手术.
- 患者被分为手术不合格 (n=8,平均年龄84.5) 和手术拒绝 (n=27,平均年龄88.0) 组.
- 评估了包括住院死亡率,死亡原因和中期存活率在内的结果.
主要成果:
- 研究队列的整体住院死亡率为51.4%.
- 手术不合格患者的死亡率为100%,那些拒绝手术的患者的死亡率为37%.
- 拒绝手术的住院幸存者的中期存活率为81.9%±9%.
结论:
- 在老年,高风险患者中,AAAD的非手术治疗导致显著的死亡率,特别是在那些被认为是不可手术的患者中.
- 对于那些适合接受手术但拒绝接受手术的患者来说,37%的住院死亡率凸显了保守治疗的风险.
- 这些发现为患者,家庭和临床医生之间关于AAAD治疗的共同决策提供了关键的基准.
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