破裂性腹主動脈瘤圍術期死亡的危險因素分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

阿卜來海提·麥提色依提 , 慈紅波 , 方青波 ,  戈小虎

新疆維吾爾自治區人民醫院血管外科（烏魯木齊 830001）;

Corresponding?author：

戈小虎, Email: gexiaohuxj@126.com

Keywords：

腹主動脈瘤; 破裂; 死亡; 危險因素

DOI：

10.7507/1007-9424.202506121

Video：

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目的分析破裂性腹主動脈瘤（ruptured abdominal aortic aneurysm，rAAA）圍術期死亡相關的危險因素。方法回顧性分析2013年1月至2023年12月期間新疆維吾爾自治區人民醫院血管外科收治的rAAA且接受腔內或開放修復手術患者的臨床資料。主要終點事件為圍術期（術后30 d內）死亡，同時分析影響圍術期死亡的危險因素。結果本研究共納入54例rAAA患者，其中35例患者接受腔內動脈瘤修復術（endovascular aneurysm repair，EVAR），19例行腹主動脈瘤切除+人工血管置換術［簡稱“開放修復術（open surgical repair，OSR）”］。總死亡12例（22.2%），其中EVAR后5例（9.3%）、OSR后7例（13.0%），EVAR組圍術期死亡率與OSR組比較差異無統計學意義（χ²=2.438、P=0.118）。多因素分析結果顯示，格拉斯哥動脈瘤評分越低和腹主動脈瘤最大直徑越小是rAAA患者術后圍術期死亡的保護因素［OR（95%CI）=0.899（0.819，0.986），P=0.024； OR（95%CI）=0.088（0.014，0.570），P=0.011］。結論本研究結果提示，格拉斯哥動脈瘤評分升高和腹主動脈瘤最大直徑增加是rAAA患者圍術期死亡的獨立危險因素，提示在臨床救治中應重點關注此類高危患者，并綜合考慮其解剖與生理狀態，以優化治療策略及改善患者預后。

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2.	Golledge J, Thanigaimani S, Powell JT, et al. Pathogenesis and management of abdominal aortic aneurysm. Eur Heart J, 2023, 44(29): 2682-2697.
3.	Oliveira-Pinto J, Sousa J, Mansilha A. Treatment of ruptured abdominal aortic aneurysms: state of the art. Acta Med Port, 2018, 31(4): 213-218.
4.	Reimerink JJ, Hoornweg LL, Vahl AC, et al. Endovascular repair versus open repair of ruptured abdominal aortic aneurysms: a multicenter randomized controlled trial. Ann Surg, 2013, 258(2): 248-256.
5.	IMPROVE Trial Investigators; Powell JT, Sweeting MJ, et al. Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial. BMJ, 2014, 348: f7661. doi: 10.1136/bmj.f7661.
6.	Desgranges P, Kobeiter H, Katsahian S, et al. Editor’s choice—ECAR (Endovasculaire ou Chirurgie dans les Anévrysmes aorto-iliaques Rompus): a French randomized controlled trial of endovascular versus open surgical repair of ruptured aorto-iliac aneurysms. Eur J Vasc Endovasc Surg, 2015, 50(3): 303-310.
7.	Park BD, Azefor N, Huang CC, et al. Trends in treatment of ruptured abdominal aortic aneurysm: impact of endovascular repair and implications for future care. J Am Coll Surg, 2013, 216(4): 745-754.
8.	Dang VC, Osztrogonacz PJ, Haddad P, et al. Houston Methodist ruptured abdominal aortic aneurysm guidelines. Methodist Debakey Cardiovasc J, 2023, 19(2): 78-89.
9.	Zhang S, Feng J, Li H, et al. Open surgery (OS) versus endovascular aneurysm repair (EVAR) for hemodynamically stable and unstable ruptured abdominal aortic aneurysm (rAAA). Heart Vessels, 2016, 31(8): 1291-1302.
10.	Antonopoulos CN, Kakisis JD, Andrikopoulos V, et al. Predictors affecting in-hospital mortality of ruptured abdominal aortic aneurysms: a Greek multicenter study. Ann Vasc Surg, 2014, 28(6): 1384-1390.
11.	Agrawal A, Snow R, Lehman E, et al. Factors affecting patients’ functional status and their impact on outcomes of ruptured abdominal aortic aneurysms. J Vasc Surg, 2018, 68(3): 712-719.
12.	?zen A, Y?lmaz M, Yi?it G, et al. Glasgow Aneurysm Score: a predictor of long-term mortality following endovascular repair of abdominal aortic aneurysm?. BMC Cardiovasc Disord, 2021, 21(1): 551. doi: 10.1186/s12872-021-02366-y.
13.	Gormley S, Mao J, Sedrakyan A, et al. The association of ruptured abdominal aortic aneurysm diameter with mortality in the International Consortium of Vascular Registries. J Vasc Surg, 2024, 79(4): 748-754. e2. doi: 10.1016/j.jvs.2023.11.033.

1. Wanhainen A, Van Herzeele I, Bastos Goncalves F, et al. Editor’s choice—European Society for Vascular Surgery (ESVS) 2024 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg, 2024, 67(2): 192-331.
2. Golledge J, Thanigaimani S, Powell JT, et al. Pathogenesis and management of abdominal aortic aneurysm. Eur Heart J, 2023, 44(29): 2682-2697.
3. Oliveira-Pinto J, Sousa J, Mansilha A. Treatment of ruptured abdominal aortic aneurysms: state of the art. Acta Med Port, 2018, 31(4): 213-218.
4. Reimerink JJ, Hoornweg LL, Vahl AC, et al. Endovascular repair versus open repair of ruptured abdominal aortic aneurysms: a multicenter randomized controlled trial. Ann Surg, 2013, 258(2): 248-256.
5. IMPROVE Trial Investigators; Powell JT, Sweeting MJ, et al. Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial. BMJ, 2014, 348: f7661. doi: 10.1136/bmj.f7661.
6. Desgranges P, Kobeiter H, Katsahian S, et al. Editor’s choice—ECAR (Endovasculaire ou Chirurgie dans les Anévrysmes aorto-iliaques Rompus): a French randomized controlled trial of endovascular versus open surgical repair of ruptured aorto-iliac aneurysms. Eur J Vasc Endovasc Surg, 2015, 50(3): 303-310.
7. Park BD, Azefor N, Huang CC, et al. Trends in treatment of ruptured abdominal aortic aneurysm: impact of endovascular repair and implications for future care. J Am Coll Surg, 2013, 216(4): 745-754.
8. Dang VC, Osztrogonacz PJ, Haddad P, et al. Houston Methodist ruptured abdominal aortic aneurysm guidelines. Methodist Debakey Cardiovasc J, 2023, 19(2): 78-89.
9. Zhang S, Feng J, Li H, et al. Open surgery (OS) versus endovascular aneurysm repair (EVAR) for hemodynamically stable and unstable ruptured abdominal aortic aneurysm (rAAA). Heart Vessels, 2016, 31(8): 1291-1302.
10. Antonopoulos CN, Kakisis JD, Andrikopoulos V, et al. Predictors affecting in-hospital mortality of ruptured abdominal aortic aneurysms: a Greek multicenter study. Ann Vasc Surg, 2014, 28(6): 1384-1390.
11. Agrawal A, Snow R, Lehman E, et al. Factors affecting patients’ functional status and their impact on outcomes of ruptured abdominal aortic aneurysms. J Vasc Surg, 2018, 68(3): 712-719.
12. ?zen A, Y?lmaz M, Yi?it G, et al. Glasgow Aneurysm Score: a predictor of long-term mortality following endovascular repair of abdominal aortic aneurysm?. BMC Cardiovasc Disord, 2021, 21(1): 551. doi: 10.1186/s12872-021-02366-y.
13. Gormley S, Mao J, Sedrakyan A, et al. The association of ruptured abdominal aortic aneurysm diameter with mortality in the International Consortium of Vascular Registries. J Vasc Surg, 2024, 79(4): 748-754. e2. doi: 10.1016/j.jvs.2023.11.033.

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