腹主动脉瘤破裂的急救与护理

腹主动脉瘤早期诊断较困难，一旦出现腹痛、腰背部疼痛等症状，瘤体已濒临破裂边缘，一旦破裂，治疗存活率仅为10％～50％。我院从1995年1月至2004年2月共收治腹主动脉瘤破裂患者12例，经积极抢救与有效护理，围手术期死亡5例，病死率为41．6％，其余均痊愈出院。现将急救与护理体会报告如下。     

胸、腹主动脉瘤破裂手术治疗(附8例报告)

①目的 总结胸、腹主动脉瘤破裂(RAAA)诊治经验。②方法 回顾性分析8例RAAA病人。肾动脉上段RAAA3例，1例胸腹联合切口，2例腹部切口，均采用Crowford方法吻合。5例肾动脉下段RAAA行传统腹部切口手术。③结果 手术后1月内死亡和长期生存均为3例。术后并发症有：脑卒中、肾衰竭、成人型呼吸窘迫综合征(ARDS)和消化道出血。④结论减少围手术期输血量、纠正休克、缩短病人等待手术时间、选择适当的麻醉及手术方法、改善凝血功能障碍、预防出血、纠正肾衰竭和ARDS等措施，均有助于降低RAAA的手术病死率。控制感染、纠正酸碱平衡紊乱和负氮平衡也是围手术期重要处理措施。     

腹主动脉瘤破裂的术前急救配合与护理

目的：探讨腹主动脉瘤破裂的术前急救配合与护理。方法：回顾12年间收治的42例腹主动脉瘤破裂的术前急救配合,对患者进行心理及专科护理。结果：患者的年龄、心理、知识程度对术前的急救效果有很大的影响。结论：术前的急救配合与护理对手术的成功起很关键的作用。     

人工血管移植术治疗腹主动脉瘤破裂22例

目的 总结腹主动脉瘤破裂手术治疗的方法及预后.方法 回顾性分析22例行人工血管移植术患者的临床资料.结果 手术中死亡1例,术后1个月内死亡6例.余15例术后存活时间超过3个月.结论 腹主动脉瘤破裂预后凶险,及时、准确的诊断和手术治疗,积极处理术后并发症可提高存活率.     

成功抢救腹主动脉瘤破裂1例

【病例】男性 ,6 2岁。既往有“高血压病、胆囊结石”病史。患者 1+年前曾于我院行ＭＲＩ及主动脉造影示 :腹主动脉及右髂总动脉瘤 ,可见斑块 ,未见附壁血栓 ;一直内科保守治疗。 2天前出现腰部持续性隐痛及四肢乏力 ,未注意。半天前腰痛明显加重 ,伴大汗淋漓、面色苍白、频繁呕吐入院。体查 :ＢＰ 2 5 / 14 5ｋＰａ ,急性痛苦面容 ,全身皮肤湿冷 ,心肺听诊无异常 ;腹胀 ,全腹轻压痛 ,肝脾不大 ,腹水征可疑阳性 ,肠鸣音减弱 ;双侧足背动脉搏动良好。查ＭＲＩ示 :腹主动脉及右髂总动脉瘤并破裂 ,可见附壁血栓。冠脉及腹主动脉造影示　① 肾…     

腹主动脉瘤外科治疗若干问题探讨（附81例报告）

报告腹主动脉瘤外科治疗８１例，对其诊断，手术时机的选择，手术方法及常见术后并发症等问题进行了探讨，认为无创伤性的彩色多普勒超声波检查可列为腹主动脉瘤的常规诊断方法，腹主动脉瘤一旦确诊应及早手术，有症状者是破裂前期，及时手术提高生存率为关键，术中应注意手术技巧的改进和防止松钳性休克的发生；术中，术后维持血流动力学稳定，严的脑心肾监护，防止急性心肌梗塞和肾功能衰竭等致死性并发症的发生，本组手术治疗５９     

腹主动脉瘤破裂1例护理体会

1病例介绍患者,男,55岁．因腰腹酸痛,腹部拳头大小搏动性肿块半月余,CT显示"腹主动脉瘤"于1998年2月6日15：30收住入院。入院后严密监测血压,腹痛情况．积极做各项术前准备、十2月8日凌晨1：00在低温全麻下行腹主动脉一骼股人造血管置换重建术。手术历时5h．术中输血4000ml,补液3000ml．术后进ICU监护,2月12日转入普通病房．2月23日痊愈出院。2术前护理2．1严密观察病情腹主动脉瘤使腹主动脉的管壁扩张,承受的压力明显增加,引起动脉壁的薄弱部分越来越膨胀,最后导致动脉破裂．通过血管的舒缩活动和神经调节作用而引起疼痛．同时…     

腹主动脉瘤破裂1例的分析

1 病例介绍 患者,男,75岁,来院时呈昏迷状态,体温不升,脉搏132次/min,呼吸23次/min,血压85/45 mm Hg,皮肤苍白,睑结膜苍白,两侧瞳孔等大等圆,直径约4 mm,对光反射灵敏,双肺呼吸音清晰,无干湿啰音,心率132次/min,律齐,无杂音.腹部轻度膨隆,未触及明显肿块,移动性浊音可疑阳性,肠鸣音正常.余无明显异常.     

腹主动脉瘤先兆破裂及破裂的CT征象(附10例分析)

目的探讨腹主动脉瘤先兆破裂及破裂在多层螺旋CT中的表现。方法收集10例临床证实腹主动脉瘤的患者的CT扫描资料进行回顾性分析。结果腹主动脉瘤先兆破裂的CT征象:动脉瘤大小增加、附壁血栓和环状钙化的管壁出现局部连续中断及高密度新月征;腹主动脉瘤破裂的CT征象:腹膜后血肿和动脉包含征。结论 CT可显示腹主动脉瘤先兆破裂及破裂的CT征象,及时做出诊断。     

破裂腹主动脉瘤腔内治疗与手术治疗效果比较

目的:比较破裂腹主动脉瘤（rAAA）腔内治疗（EVAR）与开放手术（OSR）的治疗情况。方法:回顾性分析分别采取开放手术或腔内治疗的rAAA患者临床资料。比较两组术前一般情况、围手术期死亡率及并发症发生率、术后死亡率、术后住院时间等。结果:rAAA患者共35例,其中男28例,女7例,年龄37～84岁,平均(68.37±10.04)岁。 OSR 23例、 EVAR 12例。 两组在年龄、性别、合并症及术前血流动力学稳定性方面无显著性差异（P＞0.05）。OSR组与EVAR组的死亡率依次为:手术期17.4%（4/23）、0（0/12）（P=0.275）,术后30 d死亡率30.4%（7/23）、0（0/12）（P=0.070）,术后6个月34.8%（8/23）、0.0%（0/12）（P=0.032）,术后12个月45.0%（9/20）、0（0/8）（P=0.029）;两组术后住院天数中位数分别是:OSR 17.0 (IQR:14.0～27.0),EVAR 11.0 (IQR:7.0～16.0) (P=0.024)。结论:腔内治疗可作为rAAA的一线治疗手段,但应根据解剖条件进行手术方式的选择 。单臂支架型血管（AUI）是控制rAAA出血的快速、有效方式。EVAR术后必需加强对腹腔间隔室综合征的观察与处理。     

Two operative cases of abdominal aortic aneurysm with isolated dissection of the abdominal aorta

Objective: Isolated abdominal aortic dissection (IAAD) co-occurring with an abdominal aortic aneurysm (AAA) is rather rare. The objective of this report was to discuss the adequate timing and method of surgery for this condition.Patients: We encountered two operative cases, for which we carefully considered the timing and method of surgery. One patient underwent open repair 1 month after the onset, and the other patient underwent endovascular aneurysm repair (EVAR) 3 years after the onset.Results: Both patients had a good postoperative recovery and are doing well 8 months after the surgery.Conclusion: The presence of symptoms or an increase in the diameter of an AAA is important in determining the timing of intervention.     

腔内隔绝术在破裂性腹主动脉瘤治疗中的应用

[目的]总结腔内隔绝术治疗破裂性腹主动脉瘤的经验.[方法]收集2005年1月-2011年3月采用腔内隔绝术治疗破裂性腹主动脉瘤的16例患者的临床资料.所有患者行数字减影血管造影(DSA)和/或螺旋CT血管成像检查确诊.在DSA指导下,经股动脉小切口将支架移植物导入腹主动脉内,从腔内将瘤体与血流隔绝.[结果] 16例腹主...     

“三明治”技术保留内脏动脉四分支治疗胸腹主动脉瘤

1病例资料患者,女,43岁,因"腹部隐痛3周加重1周"于2014年4月9日收治入院。患者3年前因突发胸背部疼痛于我院胸心外科诊断为:马凡综合征、主动脉夹层(Stanford A型),急诊行主动脉弓全弓置换+支架象鼻术(直径28mm)。术后恢复好,口服华法林抗凝(3.75mg/d),国际标准化比值维持在2~3。1年前行心脏永久性起搏器植入术。3周前腹部隐痛,逐渐加重,CT提示象鼻支架远端降主动脉假腔未完全血栓化,近膈肌段假腔扩张,腹主动脉真性动脉瘤,动脉瘤最大直径     

破裂腹主动脉瘤腔内修复与开放手术效果的比较

目的:比较破裂腹主动脉瘤（rAAA）开放手术（OR）与腔内治疗（EVAR）的治疗效果。方法:回顾性分析确诊rAAA并采取OR或EVAR治疗患者的临床资料。比较两组患者及其中游离破裂患者术前指标及合并症、术中指标、围术期死亡率、术后并发症、术后住院天数及生存率等。结果:共61例rAAA 患者,男性50例,女性11例,年龄37～86岁,平均（69.74±9.22）岁。OR组36例,EVAR组25例。两组在年龄、性别、合并症及血肌酐方面无显著性差异（P＞0.05）,而在术前血流动力学稳定性方面存在显著性差异（P <0.05）。OR组与EVAR组围术期死亡率,术后30 d、6个月及12个月生存率均无显著性差异（P＞0.05）;OR组与EVAR组在术中出血量[（2116.67±1655.52）、（339.58±786.29） mL],术中输血量[ (1413.33±978.29) 、（416.67±562.35） mL],手术时长[（279.33±66.87） min 、（161.46±82.81) min]及ICU天数[5.0（IQR:2.0～6.0）,1.0（IQR:0.0～2.0）] 方面存在显著性差异（P <0.001）。其中两组间游离破裂患者各指标均无显著性差异（P >0.05）。结论:EVAR在解剖结构合适、指征明确的患者中的应用,可显著改善预后并具有微创优势,同时在血流动力学不稳定患者中疗效不亚于OR,故EVAR可作为rAAA治疗的一线手段;而OR在解剖结构不适用于EVAR等病例中仍发挥着不可替代的作用。     

Comparison of clinical curative effect between open surgery and endovascular repair of abdominal aortic aneurysm in China

Objective   To compare clinical curative effects of open surgery (OS) or endovascular repair (EVAR) for patients with abdominal aortic aneurysm (AAA) in China.

Data sources  We performed a comprehensive search of both English and Chinese literatures involving case studies on retrograde OS or EVAR of AAA in China from January 1976 to December 2010.

Study selection  According to the inclusion criteria, 76 articles were finally analyzed to compare patient characteristics, clinical success, complications, and prognosis.

Results  We analyzed a total of 2862 patients with 1757 undergoing OS (OS group) and 1105 undergoing EVAR (EVAR group). There was no significant difference in the success rate of the procedures. Operative time, length of ICU stay, fasting time, duration of total postoperative stay, blood loss, and blood transfusion requirements during the procedure were significantly lower in the EVAR group. A 30-day follow up revealed more cardiac, renal, pulmonary, and visceral complications in the OS group (P <0.01). Low-limb ischemia, however, was more common in the EVAR group (P <0.05). The 30-day mortality rate, including aorta-related and non-aorta related mortality, was significantly lower in the EVAR group (P <0.01). In the follow-up period, there were more patients with occlusions of artificial vessel and late endoleak in the EVAR group (P <0.01). The overall late mortality rate was higher in the OS group (P <0.01), especially non-aorta-related late mortality and mortality during the fourth to the sixth year (P <0.01).

Conclusions  EVAR was safer and less invasive for AAA patients. Patients suffered fewer complications and recovered sooner. However, complications such as artificial vessel occlusion, low-limb ischemia, and endoleak were common in EVAR. Clinicians should carry out further research to solve these complications and improve the efficacy of EVAR.

     

Fenestrated endovascular aortic repair for juxtarenal abdominal aortic aneurysm

Background Endovascular stent-graft with fenestration can improve proximal sealing in patients with juxtarenal abdominal aortic aneurysm (JAAA).The purpose of this study was to describe our primary exp...     

Endovascular aneurysm repair as a mean of treatment for ruptured abdominal aortic aneurysms

The metamorphosis of abdominal aortic aneurysm (AAA) repair from open surgical to endovascular means has evolved substantially over the past 2 decades.Today,endovascular abdominal aneurysm repair (EVAR)is considered as the first choice of therapy for treatment of infrarenal AAA in patients with favorable morphology.Furthermore,in "real world" clinical scenarios,with increasing physician experience and ability,the indications of EVAR have expanded from treatment of elective to emergent aneurysms and from favorable morphology to sometimes complex and unfavorable anatomy,particularly in high-risk patients.1-4 When considering these endovascular techniques for treating ruptured AAA,one has to prepare for the challenges of streamlining patient care from the emergency room to the operating room and subsequent endovascular procedure that often requires a multidisciplinary approach and a change in paradigm and local cultures.This paper will focus on a comprehensive and standardized technical approach for treating patients presenting with ruptured AAA by endovascular means that can maximize our ability to offer this treatment of most patients and optimize outcomes.     

Atmospheric pressure variations and abdominal aortic aneurysm rupture

Background  Ruptured abdominal aortic aneurysm (RAAA) presents with increased frequency in the winter and spring months. Seasonal changes in atmospheric pressure mirrors this pattern. Aim  To establish if there was a seasonal variation in the occurrence of RAAA and to determine if there was any association with atmospheric pressure changes. Methods  A retrospective cohort-based study was performed. Daily atmospheric pressure readings for the region were obtained. Results  There was a statistically significant monthly variation in RAAA presentation with 107 cases (52.5%) occurring from November to March. The monthly number of RAAA and the mean atmospheric pressure in the previous month were inversely related (r = -0.752, r ² = 0.566, P = 0.03), and there was significantly greater daily atmospheric pressure variability on days when patients with RAAA were admitted. Conclusion  These findings suggest a relationship between atmospheric pressure and RAAA.     

肾下型腹主动脉瘤的外科治疗

目的: 总结肾下型腹主动脉瘤(abdominal aortic aneurysms,AAA)外科治疗经验。方法: 对25例肾下型腹主动脉瘤分别行传统外科手术19例,腔内修复术4例,非手术治疗2例。结果: 23例施行手术,死亡2例,均为AAA破裂急诊手术者,其中1例术后死于多器官功能障碍综合征,1例术后死于呼吸道感染、急性呼吸窘迫综合征。另2例AAA破裂患者因病情危重未治病死。围手术期死亡率为8.7%,其中择期手术为0,急诊手术为50%。随访18例,随访时间3个月至6年,无动脉瘤复发,无吻合口假性动脉瘤,无吻合口破裂出血,手术后人工血管通畅。腔内修复术患者支架无移位,通畅,无肠缺血、无内漏发生。结论: 手术切除腹主动脉瘤疗效是满意、安全的。腔内治疗特别适用于高危患者。