腹主动脉瘤合并冠心病的临床特点及围术期处理  

Clinical characteristics and perioperative management of abdominal aortic aneurysm complicated with coronary heart disease

作　　者：杨耀国[1,2] 陈忠[1,2] 唐小斌[1,2] 寇镭[1,2] 吴章敏[1,2] 刘晖[1,2] 王盛[1,2] 张征[1,2] 贾云峰[1,2] 何楠[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院血管科 [2]首都医科大学血管外科学系,北京100029

出　　处：《首都医科大学学报》2015年第1期23-27,共5页Journal of Capital Medical University

基　　金：国家自然科学基金(81070256;81100226);首都医学发展科研基金(2007-1027)~~

摘　　要：目的总结合并冠状动脉粥样硬化性心脏病(以下简称冠心病)的腹主动脉瘤(abdominal aortic aneurysm,AAA)患者的临床发病特点及围术期的处理。方法回顾1991年1月至2014年8月间AAA围术期合并冠心病的患者225例作为研究组,同时以手术方式(开放手术和腔内治疗)为匹配因素选取不合并冠心病的患者225例为对照组,对治疗效果及出现的合并症进行分析。结果研究组与对照组相比术前检查中糖尿病与高脂血症发病率高(P<0.01),低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)与LDL-C/高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)增高(P<0.01),HDL-C降低差异均有统计学意义(P<0.01)。研究组围术期循环系统、呼吸系统合并症率较对照组高,分别为19.1%(43/225)和7.6%(17/225),差异有统计学意义(P<0.05,P<0.01),围术期手术失血量、重症监护室(intensive care unit,ICU)入住时间等比较,差异无统计学意义,合并症合计在研究组增高,差异有统计学意义(P<0.01)。行腔内治疗的患者总体合并症率小于行开放手术者(29.2%vs 14.5%,P<0.01)。结论合并冠心病的AAA患者应注意糖尿病、高脂血症的控制,如果解剖条件合适应首选腔内治疗。给患者以精心细致的围术期处理,有利于减少术后合并症的出现。Objective To investigate clinical features and perioperative treatment experience of abdominal aortic aneurysm（ AAA）complicated with coronary heart disease. Methods A retrospective analysis was performed on 225 patients with perioperative AAA complicated with coronary artery disease（ CAD） seen from January 1991 to August 2014 as study group,and another 225 cases with AAA without CAD treated with open surgery or endovascular aneurysm repair as control group. Treatment and complications were analyzed.Results Compared with the control group,preoperative inspection of diabetes and hyperlipidemia showed a high incidence（ P〈0. 01） in the study group. The proportions of cases with low density lipoprotein-cholesterol（ LDL-C） and LDL-C/high density lipoproteincholesterol（ HDL-C） increased（ P〈0. 01）,HDL-C（ P〈0. 01） decreased were significantly higher in the study group. Perioperative complication rate of circulatory and respiratory system was higher in the study group 19. 1%（ 43 /225）,7. 6%（ 17 /225）,the difference was statistically significant（ P〈0. 01,P〈0. 05）. There was no significant difference in perioperative blood loss and intensive care unit（ ICU） stay. Total complications in the study group increased significantly（ P〈0. 01）. Conclusion For patients with AAA complicated with coronary heart disease,attention should also be paid to the control of diabetes,hyperlipidemia,and take reasonable surgical program according to the disease status. If the anatomical conditions are suitable,endovascular aneurysm rapair（ EVAR） is the treatment of choice. We should provide a careful and meticulous perioperative management to AAA patients to reduce postoperative complications.

关 键 词：动脉瘤 冠状动脉粥样硬化性心脏病 围术期 

分 类 号：R654.3[医药卫生—外科学]