破裂性腹主动脉瘤急诊腔内修复术可行性疗效分析

Feasibility and Efficacy Analysis of Emergency Endovascular Repair of Ruptured Abdominal Aortic Aneurysm

摘要: 目的：分析破裂性腹主动脉瘤(RAAA)腔内修复的效果及预后，评价其疗效，总结治疗经验。方法：回顾性研究分析2017年9月至2022年9月青岛大学附属医院血管外科收治的32例真性破裂腹主动脉瘤的腔内修复手术治疗的临床资料，分析其解剖学特点，术后30天死亡率，住院时间，手术时间，输血量，ICU停留时间，术后并发症发生率。结果：在32例RAAA患者中，血压难以维持、血流动力学不稳定组的患者死亡率比稳定组显著提高。术中死亡1例(快速性房颤)，术后死亡10例，1例死于腹腔感染，1例死于术后急性心梗，1例多脏器功能障碍，6例死于进行性休克，1例死于急性肾衰竭。接受外科干预的患者中，总体30 d死亡率为29.1% (11/32)。结论：破裂腹主动脉瘤发病急，病情危重，病死率高，EVAR是早期安全有效的救治方式。

Abstract: Objective: To analyze the effect and prognosis of endovascular repair of ruptured abdominal aortic aneurysm (RAAA), evaluate its curative effect and summarize the treatment experience. Methods: The clinical data of 32 cases of true ruptured abdominal aortic aneurysm treated by endovascular repair surgery in the Affiliated Hospital of Qingdao University from September 2017 to September 2022 were retrospectively analyzed, and their anatomical characteristics, 30-day postoperative mortality, hospitalization time, operation time, blood transfusion, ICU stay time and postoperative complications were analyzed. Results: Among 32 patients with ruptured abdominal aortic aneu-rysms, the mortality rate of patients in the group with difficulty maintaining blood pressure and unstable hemodynamics was significantly further than that in the stable group. One case died dur-ing the operation (rapid atrial fibrillation), and 10 cases died after the operation, 1 died of ab-dominal infection, 1 died of postoperative acute myocardial infarction, 1 died of multiple organ dysfunction, 6 died of progressive shock, and 1 died of acute renal failure. Among patients who un-derwent surgical intervention, the overall 30 d mortality was 29.1% (11/32). Conclusion: Ruptured abdominal aortic aneurysm has the characteristics of acute onset, critical condition and high mor-tality. EVAR is a safe and effective early treatment.