腹主动脉瘤破裂手术治疗预后及危险因素分析

Study on the prognostic factor of patients with ruptured abdominal aortic aneurysm after surgery

目的分析影响腹主动脉瘤破裂病人手术治疗预后的危险因素。方法回顾性分析1999年8月至2010年12月重庆医科大学附属第一医院行手术治疗的40例腹主动脉瘤破裂病人资料。从病人年龄、性别、合并其他基础疾病、瘤体直径、输血量、手术时间以及术前低血压持续时间几方面进行研究,采用单因素分析和多因素分析了解影响腹主动脉瘤破裂病人手术治疗预后的危险因素。结果单因素分析:术前有低血压表现的病人(P=0.034)死亡风险为术前无低血压病人的3.2倍,低血压持续时间≥2h病人(P=0.008)为低血压持续时间<2h病人的2.6倍。术前合并冠心病(P=0.028)、慢性阻塞性肺疾病(P=0.012)及肾功能不全(P=0.028)的病人病死率显著升高。病人年龄≥70岁的(P=0.031)和瘤体直径≥5cm的病人(P=0.016)病死率显著升高。病人病死率与输血量(P=0.225)、性别(P=0.689)及手术时间(P=0.360)无明显关系。多因素分析:低血压持续时间(P=0.042)、术前合并冠心病(P=0.036)和年龄(P=0.040)三种因素差异有统计学意义,而术前合并慢性阻塞性肺疾病(P=0.102)、肾功能不全(P=0.057)和瘤体直径(P=0.225)在多因素分析中差异无统计学意义。结论低血压持续时间、合并冠心病和高龄是影响腹主动脉瘤破裂病人预后的危险因素。缩短低血压持续时间可以明显改善腹主动脉瘤破裂病人预后。

Objective To analyze the prognostic factor of patients with ruptured abdominal aortic aneurysm （RAAA） after surgery. Methods The data of 40 patients with RAAA performed surgery between August 1999 and December 2010 in the First Affiliated Hospital of Chongqing University of Medical Sciences were analyzed retrospectively by age, gender, comorbidities, diameter of aneurysm, blood transfusion, operation time and duration of hypotension. The relationship of the variables with mortality was analyzed by both univariate and muhivariate analyses. Results In the univariate analysis： patients with hypotension（P=0.034） presented with 3.2 times mortality compared to patients without hypotension. Patients with duration of hypotension≥2h（P=0.008） presented with 2.6 times mortality compared to patients with duration of hypotension〈2h. An increased mortality was observed in patients with coronary heart disease（P= 0.028）, chronic obstructive pulmonary disease（P=O.O12） and renal dysfunction（P-0.028）. An increased mortality was observed in patients older than 70 years（P=0.031） and in diameter of aneurysm bigger than 5cm（P=0.016）. The relationship of mortality to gender（P=0.689）, blood transfusion（P=0.225） and operation time（P=0.360） was not significant. In the multivariate analysis： the test showed as significant as age（P=0.040）, patients with coronary heart disease（P=0.036） and duration of hypotension（P=0.042） but not diameter of aneurysm（P=0.225） and other disease. Conclusion Elder, coronary heart disease and duration of hypotensiou≥2h are the risk factors of prognosis for patients with RAAA. Shorten the duration of hypotension can improve the prognosis of patients with RAAA significantly.