腹主动脉瘤开放手术循环系统并发症分析  

Risk factors and preventive strategies for circulatory system complications during perioperative period of abdominal aortic aneurysm

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

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

出　　处：《中华普通外科杂志》2015年第8期592-595,共4页Chinese Journal of General Surgery

基　　金：首都医学发展科研基金资助项目（2007-1027）,国家自然科学基金资助项目（81070256,81100226）

摘　　要：目的探讨腹主动脉瘤（abdominal aortic aneurysm，AAA）开放手术后围手术期循环系统并发症的风险因素及预防策略。方法回顾性分析1991年1月至2015年2月采用开放手术方法治疗AAA患者443例，术后有循环系统并发症的患者47例，同时以入院时间及术者为匹配因素随机选取无循环系统并发症的患者47例作为对照组。对2组术前合并疾病、围手术期血压波动、血红蛋白变化、手术失血量、输血量、手术时间、ICU时间等进行比较。结果围手术期循环系统并发症发生率为10．6％（47／443），包括心功能不全16例，心衰9例，心肌梗死13例，心律失常9例。其中因心肌梗死死亡3例．因心律失常死亡1例。2组间比较显示冠心病（P〈0．01）、糖尿病（P〈0．05）、LDL—C／HDL—C增高（P〈0．01）、术后血红蛋白下降（P〈0．05）、围手术期低血压（P〈0．01）、手术失血量（P〈0．05）是出现循环系统并发症的危险因素。结论严格管理冠心病、糖尿病、血脂异常等、精细熟练的手术操作和减少因失血导致的低血压是预防循环系统并发症的关键。Objective To explore the risk factors and preventive strategy of the circulatory system complications after open surgery of abdominal aortic aneurysm （AAA）. Methods 47 in 443 AAA cases from January 1991 to February 2015 developed circulatory system complications after open surgery. Those were matched with 47 AAA patients without circulatory system complications. Risk factors such as preoperative comorbidities, perioperative blood pressure fluctuations, change of hemoglobin, operative blood loss, blood transfusion volume, operation time and ICU time were compared. Results Perioperative complication rate in circulatory system was 10. 6% （47/443）, including cardiac insufficience in 16 cases heart failure in 9 cases, arrhythmia in 9 cases, myocardial infarction in 13 cases. 3 died of myocardial infarction and one died of arrhythmia. Coronary heart disease （ P 〈 0. 01 ）, diabetes （ P 〈 0.05 ）, LDL-C/ HDL-C increased （ P 〈 0. 01 ） , postoperative hemoglobin decrease （ P 〈 0. 05 ）, perioperative hypotension （P 〈0. 01 ）, surgical blood loss （P 〈 0. 05 ） are the risk factors of the circulatory system complications. Conclusions Management of coronary heart disease, diabetes, dyslipidemia fine and skilled operation and meticulous perioperative management to reduce risk factors such as hemorrhagic hypotension are keys to prevent circulatory complications.

关 键 词：主动脉瘤 腹 手术后并发症 心血管系统 

分 类 号：R657.4[医药卫生—外科学]