腹主动脉瘤破裂的预后影响因素分析

Factors affecting the prognosis of ruptured abdominal aortic aneurysm

目的 探讨影响腹主动脉瘤破裂的预后影响因素.方法 回顾性分析中山大学附属第一医院自1980年1月至2013年5月间收治的85例破裂型腹主动脉瘤患者的临床资料.从腹主动脉瘤破裂的疾病相关因素和手术相关因素两方面进行研究,采用单因素分析和Logistic多元回归分析了解影响腹主动脉瘤破裂患者的预后影响因素.结果 67例行手术治疗,术后30 d病死率为35.8％.围手术期病死率为47.6％,抢救成功率为52.4％.通过单因素分析可知在腹主动脉瘤破裂的疾病相关因素中,年龄（P=0.012）、从发病到就诊时间（P=0.023）、合并冠状动脉粥样硬化性心脏病（P=0.041）或慢性阻塞性肺疾病（P=0.018）、心搏骤停（P =0.036）、休克持续时间（P =0.007）和就诊时收缩压（P=0.015）在死亡组与存活组间差异有统计学意义;手术相关因素中,从就诊到手术开始时间（P=0.001）、手术时间（P =0.024）、失血量（P =0.039）及主动脉阻断时间（P=0.030）于两组间差异有统计学意义.通过多因素分析显示年龄（P=0.049）、合并冠状动脉粥样硬化性心脏病（P=0.016）、休克持续时间（P =0.007）、从就诊到手术开始时间（P =0.025）、手术时间（P=0.041）及失血量（P=0.021）于两组间差异有统计学意义.结论 腹主动脉瘤破裂病情进展迅猛,病死率高,临床上应力求早期诊断,及时手术治疗控制出血,才能提高其存活率.

Objective To analyze the prognostic factors associated with the mortality of ruptured abdominal aortic aneurysm （RAAA）.Methods From January 1980 to May 2013,the clinical data of 85 RAAA patients were analyzed retrospectively.The risk factors were categorized into disease related and surgery related groups,and analyzed with One-way ANOVA and nultivariate Logistical regression analysis.Results There were 67 patients treated with surgical repair of RAAA.The postoperative 30-day mortality rate was 35.8%.The perioperative mortality and survival rate were 47.6% and 52.4%,respectively.On univariate analysis,the relevant factors including age,length of time elapsed from disease onset to admission,underlying disease of coronary atherosclerotic heart disease or chronic obstructive pulmonary disease,cardiac arrest,duration of shock,systolic pressure on admission,length of time consumed from the cmergency room to operation room,operative time,aortic clamping time and hemorrhage volume were statistically significant between the death and survival group.On multivariate analysis,the relevant factors including age,underlying disease of coronary atherosclerotic heart disease,duration of shock,length of time consumed from the emergency room to operation room,operative time,hemorrhage volume were statistically significant.Conclusions To increase the survival rate of RAAA,timely diagnosis and prompt operative control of bleeding are of paramount importance.