Introduction of adjuncts and their influence on changing results in 402 consecutive thoracoabdominal aortic aneurysm repairs
Introduction of adjuncts and their influence on changing results in 402 consecutive thoracoabdominal aortic aneurysm repairs
复制标题
DOI：
10.1016/j.ejcts.2004.01.033
复制
发表时间：
2004-05-01
影响因子：
3.4
通讯作者：
Boezeman, E
中科院分区：
文献类型：
--
作者：
Schepens, M;Dossche, K;Boezeman, E
目的：评估脑脊液引流（CSFD）和诱发电位对胸腹主动脉瘤（TAAA）修复术后发病率和死亡率的影响，并更新我们的经验。研究方法：在1981年2月至2003年2月期间，402名连续患者在1981年至1994年期间使用简单交叉夹闭（n = 123; CC）、左心旁路（从1987年开始：n = 254）或体外循环（it = 25; ADJ）进行了TAAA修复。264例患者使用了体感诱发电位，176例患者使用了运动诱发电位。202例患者（50.2%）使用CSFD。结果：总体住院死亡率为10.9：CC组为14.1%，ADJ组为9.1%（P = 0.07）。术后透析发生率为6.1%。截瘫合并轻瘫占11.3%。住院死亡的独立风险因素为年龄（OR 1.1/年，95% CI 1.04-1.16）、破裂（OR 3.8，95% CI 1.7-8.8）和术后血液透析（OR 8.1，95% CI 3.2-20.3）。对于术后血液透析，危险因素是年龄大于或等于75岁（OR 3.2。95%CI 1.1-9.7），术前肌酐水平高于150 μ M/l（OR 6.5，95%CI 2.6-16.2），1995年后手术（OR 0.2，95%CI 0.06-0.6）为保护因素。对于脊髓功能障碍（截瘫和轻瘫），保护因素是年龄≥ 75岁（OR 0.16，95% CI 0.02-1.2），1995年后手术（OR 0.31，95% CI 0.15-0.65）和既往主动脉夹层（OR 0.38，95% CI 0.15-0.9）。结论：多年来采用的不同药物对我们的结果产生了积极的影响。(C)2004 Elsevier B. V.保留所有权利。
Objective: To assess the influence of adjuncts, cerebrospinal fluid drainage (CSFD) and evoked potentials, on morbidity and mortality after thoracoabdominal aortic aneurysm (TAAA) repair and to update our experience. Methods: Between February 1981 and February 2003, 402 consecutive patients underwent repair of their TAAA using simple cross-clamping between 1981 and 1994 (n = 123; CC), left heart bypass (from 1987: n = 254) or extracorporeal circulation (it = 25; ADJ). Somatosensory evoked potentials were used in 264 patients and motor evoked potentials in 176 patients. CSFD was used in 202 patients (50.2%). Results: Overall hospital mortality was 10.9:14.1% in the CC-group versus 9.1 % in the ADJ-group (P = 0.07). The incidence of postoperative dialysis was 6.1%. Paraplegia and paraparesis together was found in 11.3%. Independent risk factors for hospital mortality were age (OR 1.1 per year, 95% CI 1.04-1.16), rupture (OR 3.8, 95% CI 1.7-8.8) and postoperative hemodialysis (OR 8.1, 95% CI 3.2-20.3). For postoperative hemodialysis the risk factors were age greater than or equal to 75 years (OR 3.2. 95% CI 1.1-9.7), a preoperative creatinine level higher than 150 muM/l (OR 6.5, 95% Cl 2.6-16.2), and as a protective factor operation performed after 1995 (OR 0.2 95% CI 0.06-0.6). For spinal cord dysfunction (Paraplegia and paraparesis together) the protective factors were age greater than or equal to 75 years (OR 0.16, 95% CI 0.02-1.2), operation performed after 1995 (OR 0.31, 95% Cl 0.15-0.65) and a previous aortic dissection (OR 0.38, 95% CI 0.15-0.9). Conclusions: The use of different adjuncts introduced over the years clearly influenced our results in a positive way. (C) 2004 Elsevier B.V. All rights reserved.