我们是否应该对急性甲型大动脉剖析患者进行手术,并进行心肺复苏?
Erik Beckmann1,2, Andreas Martens2,3, Heike Krueger2
1Center for Cardiothoracic Surgical Services, Minneapolis Heart Institute, Minneapolis, MN, USA.
概括
急性大动脉解剖A型 (AADA) 紧急手术与手术前心肺复苏 (CPR) 具有高的早期死亡率,但生存是可能的. 这些患者,即使是被直管的患者,也从手术中受益,显示可接受的长期存活率.
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
- 紧急医疗 紧急医疗
背景情况:
- 急性大动脉解剖A型 (AADA) 是一种高死亡率的危急紧急情况,特别是在需要手术前心肺复苏 (CPR) 的患者中.
- 紧急手术修复是标准的,但危急病患者的结果仍然具有挑战性.
研究的目的:
- 分析接受AADA紧急手术的患者的结果,这些患者需要手术前的CPR.
- 评估手术前心肺复苏对生存的影响,并确定影响AADA患者结果的因素.
主要方法:
- 在2000年至2023年期间,对810名因AADA而接受紧急手术的患者进行了回顾性分析.
- 对63名接受了手术前心肺复苏的患者进行了集中分析,检查了手术程序,心肺复苏细节和术后结果.
主要成果:
- 术前心肺复苏的AADA患者的30天死亡率为46%,其中65%的患者恢复了自发循环.
- 尽管早期死亡率高,但大约50%的患者从手术中受益,其1年,5年和10年生存率分别为42%,39%和36%.
- 手术前输管治疗没有显著增加30天死亡率 (54%).
结论:
- 应为所有患者提供AADA紧急手术,包括需要术前心肺复苏的患者,因为潜在的长期生存益处.
- 在心肺复苏术后进行了手术前输管和未知的神经状况的患者仍然应该考虑进行手术.
- 虽然早期死亡率很高,但成功的手术干预在这个高危人群中提供了生存和可接受的长期结果的机会.
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