主动脉腔内修复术治疗急性主动脉综合征伴中重度肾功能不全患者疗效观察

Treatment of acute aortic syndrome with moderate to severe renal insufficiency by endovascular aortic repair

目的探讨主动脉腔内修复术(EVAR)治疗急性主动脉综合征(AAS)伴中重度肾功能不全患者的近期疗效及远期预后。方法选取自2002年2月至2018年3月北部战区总医院收治的行EVAR治疗的739例AAS患者为研究对象。按肾小球滤过率的评估值(eGFR)将所有患者分为A组(n=630,eGFR>60 ml/min)和B组(n=109,eGFR≤60 ml/min)。采用倾向性评分校正两组患者年龄、性别、体质量指数、高血压病史等一般资料,分析不同肾功能状况AAS患者行EVAR治疗的近期疗效及远期预后的差异。结果 B组患者平均年龄、合并高血压比例高于A组,而男性比例、体质量指数低于A组,两组比较,差异均有统计学意义(P<0.05)。倾向性评分匹配后,两组患者性别、年龄、危险因素、既往史、临床表现、主动脉病变特征、治疗药物及手术日补液量等比较,差异均无统计学意义(P>0.05)。B组患者休克、急性肾功能衰竭、全因死亡、主动脉源性死亡发生率高于A组,两组比较,差异均有统计学意义(P<0.05)。倾向性评分匹配后,两组患者急性肾功能衰竭发生率比较,差异有统计学意义(P<0.05)。随访期间,B组患者主动脉源性死亡、脑卒中发生率显著高于A组,两组比较,差异有统计学意义(P<0.05)。倾向性评分后,两组患者随访期间内漏、脑卒中、新发主动脉夹层、全因死亡、夹层破裂死亡、总体不良事件发生率比较,差异均无统计学意义(P>0.05)。结论合并中重度肾功能不全的AAS患者行EVAR治疗后的早期效果及远期预后均不劣于正常或轻度肾功能不全患者,提示EVAR治疗AAS合并中重度肾功能不全患者同样安全有效,远期预后良好。

Objective To investigate the short-term efficacy and long-term prognosis of endovascular aortic repair(EVAR) in the treatment of acute aortic syndrome(AAS) with moderate to severe renal insufficiency.Methods A retrospective study was performed on 739 cases of patients with AAS who were admitted from February 2002 to March 2018.All patients were divided into Group A(n=630,eGFR>60 ml/minute) and B(n=109,eGFR≤60 ml/minute) according to the estimated glomerular filtration rate(eGFR).The general data of age,gender,body mass index,history of hypertension of the two groups were corrected by propensity score,and the differences of short-term efficacy and long-term prognosis of EVAR treatment in AAS patients with different renal function conditions were analyzed.Results The average age and proportion of patients with hypertension in Group B were higher than those in Group A,while the proportion of men and body mass index were lower than those in Group A,and the differences between the two groups were statistically significant(P<0.05).Gender,age,risk factors,past history,clinical manifestations,characteristics of aortic lesions,therapeutic drugs and daily fluid supplementation during surgery were not statistically significant(P>0.05).The incidence of shock,acute renal failure,all-cause death and aortic death in Group B was higher than that in Group A(P<0.05).After the propensity score was matched,the incidence of acute renal failure in the two groups was compared(P<0.05).During the follow-up period,the incidence of aortic death and stroke in Group B was significantly higher than that in Group A(P< 0.05).After propensity score,there were no statistically significant differences in the incidence of internal leakage,stroke,new aortic dissection,all-cause death,dissection rupture death,and overall adverse events between the two groups during follow-up(P>0.05).Conclusion The early effect and long-term prognosis of AAS patients treated with EVAR combined with moderate to severe renal insufficiency are not worse than those with normal or mild renal insufficiency,suggesting that EVAR treatment of AAS combined with moderate to severe renal insufficiency is also safe and effective,and the long-term prognosis is good.