破裂性腹主动脉瘤的快速通道腔内修复治疗研究

Fast-track protocol of endovascular aneurysm repair for ruptured abdominal aortic aneurysm

目的分析主动脉腔内修复技术(EVAR)治疗破裂性腹主动脉瘤(RAAA)的有效性和安全性,通过快速通道的实施,提高RAAA的救治成功率。方法回顾性分析2014年1月至2020年月12月解放军联勤保障部队第九四〇医院收治的19例RAAA患者临床资料,由急诊通过快速通道,采取EVAR优先策略,收集和分析患者的基本资料、腹主动脉瘤(AAA)解剖特点、介入手术细节、术后并发症,重点关注病死率、腹腔间隔综合征(ACS)和多脏器功能不全。结果 EVAR治疗的19例RAAA患者,年龄(73.4 ± 7.4)岁,AAA直径(67.8 ± 13.6) mm,初诊时2例患者进行心肺复苏,全身麻醉13例,局部麻醉6例,所有患者均释放支架成功。自急诊就医到手术开始时间为(84.8 ± 22.4) min,住院时间(9.7 ± 5.7) d。死亡5例(5/19),主要原因为不可逆休克1例,持续出血1例和多脏器功能衰竭3例。结论 EVAR优先策略治疗RAAA的结果良好,术前适度的复苏、快速通道的实施、规范化的介入操作技术和多学科团队合作提高了救治成功率。

Objective To analyze the effective and safety of endovascular aneurysm repair(EVAR)for ruptured abdominal aortic aneurysm(RAAA)at one tertiary center,and to improve the outcomes of RAAA under fast-track protocol.Methods Nineteen cases of RAAA in the 940th Hospital of Joint Logistic Support Force of PLA from January 2014 to December 2020 were reviewed retrospectively.EVAR-fist strategy was employed from the emergency room to the operating room by using fast-track protocol.Preoperative management,anatomic characteristics,choice of anesthesia,operative procedures and postoperative complications were collected and analyzed.Abdominal compartment syndrome(ACS)and hospital mortality were paid special attention.Results Nineteen cases were undergone EVAR procedures.The age was(73.4±7.4)years old,and the AAA size was(67.8±13.6)mm.Two cases underwent cardiopulmonary resuscitation at emergency department.General anesthesia was used in 13 patients and local anaesthesia in 6 patients.Successful stent graft deployment was achieved in all cases.The duration from emergency room to operating room was(84.8±22.4)min.The hospital stay time was(9.7±5.7)d.The hospital mortality was 5/19.The 5 deaths were reviewed:3 died for multiple organ failure,1 for irreversible shock,and 1 for ongoing bleeding.Conclusions Excellent results were confirmed by using EVAR-first strategy for RAAA.The management of hemodynamically unstable state,standardized endovascular procedure,fast-track program and multidiscipline team collaboration were the very important determining factors for the implementation of EVAR.Focused efforts to reduce RAAA mortality are warranted.