CAJ | 학술논문

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.
목적 탐토영향복주동맥류파렬적예후영향인소.방법 회고성분석중산대학부속제일의원자1980년1월지2013년5월간수치적85례파렬형복주동맥류환자적림상자료.종복주동맥류파렬적질병상관인소화수술상관인소량방면진행연구,채용단인소분석화Logistic다원회귀분석료해영향복주동맥류파렬환자적예후영향인소.결과 67례행수술치료,술후30 d병사솔위35.8％.위수술기병사솔위47.6％,창구성공솔위52.4％.통과단인소분석가지재복주동맥류파렬적질병상관인소중,년령(P=0.012)、종발병도취진시간(P=0.023)、합병관상동맥죽양경화성심장병(P=0.041)혹만성조새성폐질병(P=0.018)、심박취정(P =0.036)、휴극지속시간(P =0.007)화취진시수축압(P=0.015)재사망조여존활조간차이유통계학의의;수술상관인소중,종취진도수술개시시간(P=0.001)、수술시간(P =0.024)、실혈량(P =0.039)급주동맥조단시간(P=0.030)우량조간차이유통계학의의.통과다인소분석현시년령(P=0.049)、합병관상동맥죽양경화성심장병(P=0.016)、휴극지속시간(P =0.007)、종취진도수술개시시간(P =0.025)、수술시간(P=0.041)급실혈량(P=0.021)우량조간차이유통계학의의.결론 복주동맥류파렬병정진전신맹,병사솔고,림상상응력구조기진단,급시수술치료공제출혈,재능제고기존활솔.
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.