九例腹主动脉瘤破裂死亡原因分析

目的分析总结腹主动脉瘤破裂的死亡原因与救治经验。方法回顾性分析2001-2005年23例腹主动脉瘤破裂手术治疗后9例死亡病例的临床资料。结果23例中死亡9例,术前均伴有休克,总死亡率约39．1％。术前伴发高血压7例、COPD 1例、慢性肾功不全1例。其破裂类型包括向前壁开放性破裂5例;向脊柱左侧方破裂3例;向后方破裂1例。破裂部位分别为肾动脉3例、肾下腹主动脉领域6例。术后分别死于ARDS 4例、急性肾衰2例、人工血管感染2例、DIC 1例。结论死亡率与就诊时的休克状态、破裂部位和类型、术后并发症、人工血管感染密切相关,及时正确地诊断救治、加强围手术期监护有利于降低死亡率。

Mortality analysis of emergency surgery for ruptured abdominal aortic aneurysm, a report of 9 cases

Objective To analyze postoperative mortality of emergency surgery for ruptured abdominal aortic aneurysm ( RAAA). Methods Data of 23 RAAA cases treated by emergency open surgery between 2001 and 2005 were retrospectively reviewed. Results There were 9 death cases postoperatively, the mortality was 39. 1%. All these 9 cases suffered from shock preoperatively. Other concurrent diseases included angiocardiopathy and hypertension ( n = 7) , COPD ( n = 1) and chronic renal failure (n = 1). The type of rupture included open forward rupture (n = 5) , left sided rupture ( n = 3 ) and limited backward rupture (n = 1). Ruptures were located in abdominal aorta close to renal artery (n = 3), and in infrarenal AA( n = 6). ARDS (n = 4), acute renal failure (n = 2) , artificial blood vessel infection (n = 2) and DIC( n = 1) were among the main causes of death. Conclusions The chronic health status, preoperative shock, rupture types and postoperative complications were closely correlated with the postoperative prognosis of RAAAs. Correct diagnosis, prompt therapy and intensive perioperative care were all conducive to a decrease of RAAA mortality.