Background Acute kidney injury （AKI） is considered as a common and significant complication following abdominal aortic aneurysm （AAA） repair. This study aimed to assess the associated risk factors of AKI in the cr...Background Acute kidney injury （AKI） is considered as a common and significant complication following abdominal aortic aneurysm （AAA） repair. This study aimed to assess the associated risk factors of AKI in the critically ill patients undergoing AAA repair and to evaluate the appropriate AKI management in the specific population. Methods We retrospectively examined data from all critically ill patients undergoing AAA repairs at our institution from April 2007 to March 2012. Multivariable analysis was used to identify factors associated with postoperative AKI, which was defined by risk, injury, failure, loss and end-stage （RIFLE） kidney disease criteria. The goal-directed hemodynamic optimization （maintenance of optimal hemodynamics and neutral or negative fluid balance） and renal outcomes were also reviewed. Results Of the 71 patients enrolled, 32 （45.1%） developed AKI, with 30 （93.8%） cases diagnosed on admission to surgical intensive care unit （SICU）. Risk factors for AKI were ruptured AAA （odds ratio （OR）=5.846, 95% confidence interval （CI）： 1.346-25.390）, intraoperative hypotension （OR=6.008, 95% CI： 1.176 to 30.683）, and perioperative blood transfusion （OR=4.611, 95% CI： 1.307-16.276）. Goal-directed hemodynamic optimization resulted in 75.0% complete and 18.8% partial renal recovery. Overall in-hospital mortality was 2.8%. AKI was associated with significantly increased length of stay （（136.9±24.5） hours vs. （70.4±11.3） hours） in Surgical Intensive Care Unit. Conclusions Critically ill patients undergoing AAA repair have a high incidence of AKI, which can be early recognized by RIFLE criteria. Rupture, hypotension, and blood transfusion are the significant associated risk factors. Application of goal-directed hemodynamic optimization in this cohort appeared to be effective in improving renal outcome.展开更多
Background Although Multi-planar reconstruction （MPR） has been considered a diagnostic imaging technique that observes more perspectives for diseases,few people have applied it surgically.In fact,MPR is also very us...Background Although Multi-planar reconstruction （MPR） has been considered a diagnostic imaging technique that observes more perspectives for diseases,few people have applied it surgically.In fact,MPR is also very useful to clinical operation,especially for patients with type B aortic dissection.It helps the surgeon to locate accurately with more information about aortic dissection,so that the safety and effectiveness of operation can be improved.This study examined the application of the MPR in intraoperative DSA imaging for precise positioning by accurately obtaining a crosssection,a spin angle of the coronal plane,and a tilt angle of the sagittal plane in treatment of type B aortic dissection.Methods The conventional and the MPR approaches were compared on positioning the aortic arch for surgery.A group of 40 patients （group A） and another group of 42 patients （group B） was sampled.About the comparison of baseline characteristics,a fourfold table X2 test was conducted on gender,and two independent samples t-test was applied to age between group A and group B.Spin as well as tilt angles for group A were obtained from the patients using both approaches,and their effectiveness was compared with pair t-tests; The MPR data guided stent-grafting in this group.Stent graft placement of group B was based on the conventional approach.Percentages of proximal distributed markers as well as incidences of complications were collected from both groups after stent graft placement.They were also compared with a fourfold table X2 test.Results Gender difference was not found between group A and group B （X2=0.80,P ＞0.05）,and age difference was not statistically significant （F=2.55,homogeneity of variance,t=-1.46,P ＞0.05）.A significant difference was found between the conventional and the MPR approaches for spin angle （t=9.17） as well as tilt angle （t=-2.07）,P ＜0.05.Percentage of proximal distributed markers （5.0％） of group A was significantly lower than that of group B （42.9％）,X2=15.92,P ＜0.05;and incidence of complications （5.0％） of group A was also significant lower than that of group B （21.4％）,X2=4.76,P ＜0.05.Conclusions Application of the MPR facilitated intraoperative angle adaption and led to satisfactory DSA.It is feasible in endovascular treatment of type B aortic dissection,and can effectively and safely guide surgical operations.展开更多
文摘Background Acute kidney injury （AKI） is considered as a common and significant complication following abdominal aortic aneurysm （AAA） repair. This study aimed to assess the associated risk factors of AKI in the critically ill patients undergoing AAA repair and to evaluate the appropriate AKI management in the specific population. Methods We retrospectively examined data from all critically ill patients undergoing AAA repairs at our institution from April 2007 to March 2012. Multivariable analysis was used to identify factors associated with postoperative AKI, which was defined by risk, injury, failure, loss and end-stage （RIFLE） kidney disease criteria. The goal-directed hemodynamic optimization （maintenance of optimal hemodynamics and neutral or negative fluid balance） and renal outcomes were also reviewed. Results Of the 71 patients enrolled, 32 （45.1%） developed AKI, with 30 （93.8%） cases diagnosed on admission to surgical intensive care unit （SICU）. Risk factors for AKI were ruptured AAA （odds ratio （OR）=5.846, 95% confidence interval （CI）： 1.346-25.390）, intraoperative hypotension （OR=6.008, 95% CI： 1.176 to 30.683）, and perioperative blood transfusion （OR=4.611, 95% CI： 1.307-16.276）. Goal-directed hemodynamic optimization resulted in 75.0% complete and 18.8% partial renal recovery. Overall in-hospital mortality was 2.8%. AKI was associated with significantly increased length of stay （（136.9±24.5） hours vs. （70.4±11.3） hours） in Surgical Intensive Care Unit. Conclusions Critically ill patients undergoing AAA repair have a high incidence of AKI, which can be early recognized by RIFLE criteria. Rupture, hypotension, and blood transfusion are the significant associated risk factors. Application of goal-directed hemodynamic optimization in this cohort appeared to be effective in improving renal outcome.
文摘Background Although Multi-planar reconstruction （MPR） has been considered a diagnostic imaging technique that observes more perspectives for diseases,few people have applied it surgically.In fact,MPR is also very useful to clinical operation,especially for patients with type B aortic dissection.It helps the surgeon to locate accurately with more information about aortic dissection,so that the safety and effectiveness of operation can be improved.This study examined the application of the MPR in intraoperative DSA imaging for precise positioning by accurately obtaining a crosssection,a spin angle of the coronal plane,and a tilt angle of the sagittal plane in treatment of type B aortic dissection.Methods The conventional and the MPR approaches were compared on positioning the aortic arch for surgery.A group of 40 patients （group A） and another group of 42 patients （group B） was sampled.About the comparison of baseline characteristics,a fourfold table X2 test was conducted on gender,and two independent samples t-test was applied to age between group A and group B.Spin as well as tilt angles for group A were obtained from the patients using both approaches,and their effectiveness was compared with pair t-tests; The MPR data guided stent-grafting in this group.Stent graft placement of group B was based on the conventional approach.Percentages of proximal distributed markers as well as incidences of complications were collected from both groups after stent graft placement.They were also compared with a fourfold table X2 test.Results Gender difference was not found between group A and group B （X2=0.80,P ＞0.05）,and age difference was not statistically significant （F=2.55,homogeneity of variance,t=-1.46,P ＞0.05）.A significant difference was found between the conventional and the MPR approaches for spin angle （t=9.17） as well as tilt angle （t=-2.07）,P ＜0.05.Percentage of proximal distributed markers （5.0％） of group A was significantly lower than that of group B （42.9％）,X2=15.92,P ＜0.05;and incidence of complications （5.0％） of group A was also significant lower than that of group B （21.4％）,X2=4.76,P ＜0.05.Conclusions Application of the MPR facilitated intraoperative angle adaption and led to satisfactory DSA.It is feasible in endovascular treatment of type B aortic dissection,and can effectively and safely guide surgical operations.
