在破裂的腹腔大动脉动脉瘤中,死亡率的预测因素
Dietrich V Jehle1, Shayan Ravanassa1, Micah K Browne1
1Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, USA.
Cureus
|November 7, 2024
概括
低血压和低血清二碳酸盐水平显著增加了破裂腹腔大动脉动脉瘤 (AAA) 的死亡率. 早期检测代谢酸性症对于及时干预和改善AAA患者的存活率至关重要.
科学领域:
- 血管外科 血管外科
- 临界护理医学 临界护理医学
- 医疗信息学 医疗信息学
背景情况:
- 破裂的腹腔大动脉动脉瘤 (AAA) 携带高死亡率,需要迅速干预.
- 低血压,功能衰竭和贫血是已知的AAA破裂的不良预后因素.
- 与开放修复相比,内血管修复可能为高风险患者提供较低的死亡率选择.
研究的目的:
- 调查系统血压 (SBP) 与血清二碳酸盐水平之间的关联,以预测AAA破裂患者的90天死亡率.
- 在破裂的AAA患者中识别出血严重程度的早期标志物.
主要方法:
- 使用TrinetX数据库进行的回顾性队列研究,包括4174名破裂AAA.患者.
- 患者根据缩血压 (SBP ≤90 mmHg vs. >90 mmHg) 和血清二碳酸盐水平进行了分层.
- 90天死亡率被评估为主要结局.
主要成果:
- 破裂AAA的90天整体死亡率为28%.
- 与SBP>90 mmHg (20.1%) 患者相比,SBP ≤90 mmHg的患者的死亡率明显更高 (46.3%).
- 血清二碳酸盐水平的降低与所有SBP组的死亡率增加相关,这表明代谢性酸化是关键预测因素.
结论:
- 低血清二碳酸盐表示的低血压和代谢酸是破裂AAA中增加死亡率的显著预测因素.
- 早期识别代谢酸性症可能会在生命体征恶化之前发生,从而能够更早地进行拯救生命的干预.
- 迅速识别和管理这些标志物对于改善破裂的AAA病例的存活率至关重要.
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