患有急性甲型大动脉解剖的患者的缺血:全国性的分析
Nicholas J Goel1, John J Kelly1, William L Patrick1
1Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania; Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Philadelphia, Pennsylvania.
The Annals of thoracic surgery
|January 23, 2025
概括
急性甲型大动脉解剖 (ATAAD) 中的缺血是常见的,并显著增加了手术死亡率,结果因受影响地区而异. 部分门置换等手术策略并没有使这些高风险患者的死亡率恶化.
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
- 大动脉疾病研究研究
背景情况:
- 急性甲型大动脉解剖 (ATAAD) 是一个重大的临床挑战,死亡率高.
- perfusion 是 ATAAD 的一种并发症,进一步加剧了患者的不良结果.
- 了解 malperfusion 的范围和影响对于优化 ATAAD 治疗至关重要.
研究的目的:
- 在一个大型的全国性ATAAD患者队列中量化输血阻塞的临床负担.
- 为了评估不同手术治疗策略对ATAAD患者与无perfusion和无perfusion患者的结果的影响.
- 确定受阻 perfusion 影响最严重的特定血管床及其与死亡率的关联.
主要方法:
- 对2017-2020年胸部外科医生协会 (STS) 成人心脏手术数据库的分析.
- 包括所有接受ATAAD修复的患者.
- 基于 STS 标准的 malperfusion 的定义;用于结果分析的多变量逻辑回归.
主要成果:
- 在9958名ATAAD修复患者中,在27.7%的患者中发生了术前输血,通常影响四肢,脏和大脑循环.
- 与没有 (13.6%) 患者相比,接受perfusion (26.8%) 的患者的手术死亡率要高得多.
- 冠状动脉和中介管阻塞独立地与增加的死亡率有关;脑阻塞不是.
结论:
- 手术前输血是ATAAD的常见和严重并发症,显著增加了手术后的死亡率.
- 与 malperfusion 相关的死亡风险因受影响的特定血管区域而异.
- 部分大动脉门置换在ATAAD患者中显示出与上升大动脉或大动脉门置换相似的死亡率,不论输血状态如何.
相关概念视频
Aortic Regurgitation I: Introduction
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
Aortic Regurgitation IV: Nursing Management
A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
Aneurysm I: Introduction
An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
Aneurysm III: Interprofessional Care
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
Aneurysm IV: Nursing Management
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...


