腹主动脉瘤破裂117例患者临床资料分析  

Clinical data analysis of 117 patients with ruptured abdominal aortic aneurysm

作　　者：徐雪峰 寇镭[2] 陈峣[1] 曾哲淳[3] 李强[1] 叶清[1] 张京岚[1] Xu Xuefeng;Kou Lei;Chen Yao;Zeng Zhechun;Li Qiang;Ye Qing;Zhang Jinglan(Department of Surgical Intensive Care Unit,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Vascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Beijing Institute of Heart Lung and Blood Vessel Disease,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院综合外科重症监护室,北京100029 [2]首都医科大学附属北京安贞医院血管外科,北京100029 [3]首都医科大学附属北京安贞医院、北京市心肺血管病研究所,北京100029

出　　处：《中华内科杂志》2024年第5期468-473,共6页Chinese Journal of Internal Medicine

摘　　要：目的探讨接受手术治疗的腹主动脉瘤破裂(rAAA)患者围手术期临床特点和预后。方法回顾性分析2005年8月至2020年11月首都医科大学附属北京安贞医院综合外科重症监护室收治的接受外科手术治疗的117例rAAA患者的临床资料,包括一般临床特征、手术方式、术后并发症、病死率。结果117例rAAA患者中,男性93例(79.5%),女性24例(20.5%),中位年龄68(62,77)岁。以腹痛(115例,98.3%)为主要表现。65例(55.6%)患者行血管腔内动脉瘤修复术(EVAR),52例(44.4%)患者行开放式外科修复术(OSR)。术后常见并发症包括急性胃肠功能障碍116例(99.1%),休克89例(76.1%),急性呼吸窘迫综合征85例(72.6%),胰腺损伤56例(47.9%),凝血功能障碍55例(47.0%),弥散性血管内凝血46例(39.3%),急性肾损伤39例(33.3%),感染/脓毒症28例(23.9%),消化道出血17例(14.5%),腹腔间隙综合征12例(10.3%)。术后院内总病死率为10.3%(12/117)。术前使用缩血管药、正性肌力药、存在腹膜后血肿及术后发生腹腔间隙综合征、消化道出血、急性肾损伤、弥散性血管内凝血的患者病死率升高[分别为5/11、6/24、5/16、6/12、6/17、23.1%(9/39)、19.6%(9/46)]。结论尽管rAAA手术治疗已进入EVAR时代,但患者术后病死率仍然较高,尤其是术前存在休克、腹膜后血肿,术后出现包括腹腔间隙综合征、出凝血功能障碍和急性肾损伤并发症的患者。需对上述患者加强围术期监护和管理,以降低病死率。Objective To examine the perioperative clinical features and prognosis of patients with ruptured abdominal aortic aneurysms(rAAA)who received surgical repair.Methods The clinical data of rAAA patients who underwent surgical repair and were admitted to the Surgical Intensive Care Unit of Beijing Anzhen Hospital,Capital Medical University from August 2005 to November 2020 were retrospectively analyzed,including the general clinical features,surgical mode,intraoperative conditions,postoperative complications,and fatality rate.Results There were 117 patients with rAAA,with a median age of 68(62,77)years,including 93 men(79.5%)and 24 women(20.5%).The main clinical manifestation was abdominal pain(n=115,98.3%).Among them,65(55.6%)patients underwent endovascular aneurysm repair(EVAR),while 52(44.4%)underwent open surgical repair(OSR).The common postoperative complications include acute gastrointestinal dysfunction(n=116,99.1%),shock(n=89,76.1%),acute respiratory distress syndrome(n=85,72.6%),pancreatic injury(n=56,47.9%),coagulation dysfunction(n=55,47.0%),disseminated intravascular coagulation(n=46,39.3%),acute kidney injury(n=39,33.3%),infection/sepsis(n=28,23.9%),gastrointestinal bleeding(n=17,14.5%),and abdominal compartment syndrome(n=12,10.3%).The overall postoperative in-hospital fatality rate was 10.3%(12/117).Preoperative use of vasopressors and inotropes,retroperitoneal hematoma,and postoperative abdominal compartment syndrome,gastrointestinal hemorrhage,acute kidney injury,and diffuse intravascular coagulation significantly increased the fatality rate[5/11,6/24,5/16,6/12,6/17,23.1%(9/39),19.6%(9/46),respectively].Conclusion The postoperative mortality of rAAA patients is still high in the era of EVAR,especially in patients with preoperative existence of shock and retroperitoneal hematoma,and with postoperative abdominal compartment syndrome,coagulation dysfunction,and acute kidney injury.It is necessary to strengthen perioperative monitoring and management of these patients to reduce the fatality rate.

关 键 词：腹主动脉瘤破裂 血管腔内动脉瘤修复术 开放式外科修复手术 并发症 

分 类 号：R65[医药卫生—外科学]