腹主动脉瘤破裂外科治疗预后判断的相关因素

Correlative factors of prognostic judgement after ruptured abdo minal aortic aneurysm operation .

目的 分析与腹主动脉瘤破裂预后判断有关的危险因素。方法 １９８０ 年２ 月至１９９９ 年２ 月收治腹主动脉瘤破裂２８ 例，其中手术１５ 例，有８ 例存活，７ 例术后死亡。结果 死亡组术前血红蛋白、红细胞数平均值低于存活组（ Ｐ ＜ ００５） ，而血尿素氮和血肌酐高于存活组（ Ｐ ＜ ００５） 。死亡组的手术时间长于存活组（ Ｐ ＜００１） ，出血和输血量均明显大于存活组（ Ｐ ＜ ００１） 。术后肾功能衰竭、呼吸衰竭、意识丧失和心功能衰竭是引起死亡的重要因素。结论 对于腹主动脉瘤破裂病人应积极手术抢救。术前迅速升压，提高血红蛋白、红细胞计数，降低血肌酐和血尿素氮，保护肾、肺、心功能，以及术后对各重要器官衰竭的积极治疗，对于提高存活率有显著临床意义的。

Objective To analyse the dangerous of ruptured abdominal aortic aneurysm s( A A A)factors correlative toprognostic judge ment . Methods 28 cases with ruptured A A Aincluding 15 cases treated surgically ,of which 8 cases sur vived in our hospitalfrom Feb 1980 to Feb 1999 w ere analysed . Results The average values of hem oglobin , R B Ccountin the death group were lower than those in the survivor group before operation( P < 0 05) ,while preoperative bloodurea and creatininein the death group were higher than those in the survivor group( P < 0 05) . The average duration ofopeation in the death group w as longer than thatin the sirvivor( P < 0 01) . More lood loss and larger blood transfusionrequirem ents were associated with the patients w ho died( P < 0 01) . Postoperative renal failure ,respiratory failure ,heart failure and unconsciousness were theim portant factors resultion in death . Conclusion The patients with ruptured A A Ashould be operated in tim e . It was significant to increase the survival rate that preoperative blood pressure ,he moglobin and R B Ccount were pro m ptly heightened and blood urea and creatinine were lowered down to protectrenal ,pulm onary and heart functions ,that the failures of the im potant organs were actively corrected postoperatively .