首都医科大学学报
首都醫科大學學報
수도의과대학학보
JOURNAL OF CAPITAL UNIVERSITY OF MEDICAL SCIENCES
2015年
1期
23-27
,共5页
杨耀国%陈忠%唐小斌%寇镭%吴章敏%刘晖%王盛%张征%贾云峰%何楠
楊耀國%陳忠%唐小斌%寇鐳%吳章敏%劉暉%王盛%張徵%賈雲峰%何楠
양요국%진충%당소빈%구뢰%오장민%류휘%왕성%장정%가운봉%하남
动脉瘤%冠状动脉粥样硬化性心脏病%围术期
動脈瘤%冠狀動脈粥樣硬化性心髒病%圍術期
동맥류%관상동맥죽양경화성심장병%위술기
aneurysm%coronary heart disease(CHD)%perioperative
目的:总结合并冠状动脉粥样硬化性心脏病(以下简称冠心病)的腹主动脉瘤(abdominal aortic aneurysm,AAA)患者的临床发病特点及围术期的处理。方法回顾1991年1月至2014年8月间AAA围术期合并冠心病的患者225例作为研究组,同时以手术方式(开放手术和腔内治疗)为匹配因素选取不合并冠心病的患者225例为对照组,对治疗效果及出现的合并症进行分析。结果研究组与对照组相比术前检查中糖尿病与高脂血症发病率高(P<0.01),低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)与LDL-C/高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)增高(P<0.01),HDL-C降低差异均有统计学意义(P<0.01)。研究组围术期循环系统、呼吸系统合并症率较对照组高,分别为19.1%(43/225)和7.6%(17/225),差异有统计学意义(P<0.05,P<0.01),围术期手术失血量、重症监护室(intensive care unit,ICU)入住时间等比较,差异无统计学意义,合并症合计在研究组增高,差异有统计学意义(P<0.01)。行腔内治疗的患者总体合并症率小于行开放手术者(29.2% vs 14.5%,P<0.01)。结论合并冠心病的AAA患者应注意糖尿病、高脂血症的控制,如果解剖条件合适应首选腔内治疗。给患者以精心细致的围术期处理,有利于减少术后合并症的出现。
目的:總結閤併冠狀動脈粥樣硬化性心髒病(以下簡稱冠心病)的腹主動脈瘤(abdominal aortic aneurysm,AAA)患者的臨床髮病特點及圍術期的處理。方法迴顧1991年1月至2014年8月間AAA圍術期閤併冠心病的患者225例作為研究組,同時以手術方式(開放手術和腔內治療)為匹配因素選取不閤併冠心病的患者225例為對照組,對治療效果及齣現的閤併癥進行分析。結果研究組與對照組相比術前檢查中糖尿病與高脂血癥髮病率高(P<0.01),低密度脂蛋白膽固醇(low density lipoprotein-cholesterol,LDL-C)與LDL-C/高密度脂蛋白膽固醇(high density lipoprotein-cholesterol,HDL-C)增高(P<0.01),HDL-C降低差異均有統計學意義(P<0.01)。研究組圍術期循環繫統、呼吸繫統閤併癥率較對照組高,分彆為19.1%(43/225)和7.6%(17/225),差異有統計學意義(P<0.05,P<0.01),圍術期手術失血量、重癥鑑護室(intensive care unit,ICU)入住時間等比較,差異無統計學意義,閤併癥閤計在研究組增高,差異有統計學意義(P<0.01)。行腔內治療的患者總體閤併癥率小于行開放手術者(29.2% vs 14.5%,P<0.01)。結論閤併冠心病的AAA患者應註意糖尿病、高脂血癥的控製,如果解剖條件閤適應首選腔內治療。給患者以精心細緻的圍術期處理,有利于減少術後閤併癥的齣現。
목적:총결합병관상동맥죽양경화성심장병(이하간칭관심병)적복주동맥류(abdominal aortic aneurysm,AAA)환자적림상발병특점급위술기적처리。방법회고1991년1월지2014년8월간AAA위술기합병관심병적환자225례작위연구조,동시이수술방식(개방수술화강내치료)위필배인소선취불합병관심병적환자225례위대조조,대치료효과급출현적합병증진행분석。결과연구조여대조조상비술전검사중당뇨병여고지혈증발병솔고(P<0.01),저밀도지단백담고순(low density lipoprotein-cholesterol,LDL-C)여LDL-C/고밀도지단백담고순(high density lipoprotein-cholesterol,HDL-C)증고(P<0.01),HDL-C강저차이균유통계학의의(P<0.01)。연구조위술기순배계통、호흡계통합병증솔교대조조고,분별위19.1%(43/225)화7.6%(17/225),차이유통계학의의(P<0.05,P<0.01),위술기수술실혈량、중증감호실(intensive care unit,ICU)입주시간등비교,차이무통계학의의,합병증합계재연구조증고,차이유통계학의의(P<0.01)。행강내치료적환자총체합병증솔소우행개방수술자(29.2% vs 14.5%,P<0.01)。결론합병관심병적AAA환자응주의당뇨병、고지혈증적공제,여과해부조건합괄응수선강내치료。급환자이정심세치적위술기처리,유리우감소술후합병증적출현。
Objective To investigate clinical features and perioperative treatment experience of abdominal aortic aneurysm (AAA) complicated with coronary heart disease.Methods A retrospective analysis was performed on 225 patients with perioperative AAA complicated with coronary artery disease (CAD)seen from January 1 991 to August 201 4 as study group,and another 225 cases with AAA without CAD treated with open surgery or endovascular aneurysm repair as control group.Treatment and complications were analyzed. Results Compared with the control group,preoperative inspection of diabetes and hyperlipidemia showed a high incidence (P<0.01 )in the study group.The proportions of cases with low density lipoprotein-cholesterol (LDL-C ) and LDL-C/high density lipoprotein-cholesterol(HDL-C)increased (P<0.01 ),HDL-C (P<0.01 )decreased were significantly higher in the study group.Perioperative complication rate of circulatory and respiratory system was higher in the study group 1 9.1% (43/225 ),7.6%(1 7/225 ),the difference was statistically significant (P<0.01 ,P<0.05 ).There was no significant difference in perioperative blood loss and intensive care unit (ICU)stay.Total complications in the study group increased significantly (P<0.01 ).Conclusion For patients with AAA complicated with coronary heart disease,attention should also be paid to the control of diabetes,hyperlipidemia,and take reasonable surgical program according to the disease status.If the anatomical conditions are suitable,endovascular aneurysm rapair (EVAR)is the treatment of choice.We should provide a careful and meticulous perioperative management to AAA patients to reduce postoperative complications.