Positive fluid balance is associated with complications after elective open infrarenal abdominal aortic aneurysm repair
Positive fluid balance is associated with complications after elective open infrarenal abdominal aortic aneurysm repair
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DOI：
10.1016/j.ejvs.2007.03.010
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发表时间：
2007-11-01
影响因子：
5.7
通讯作者：
Harkin, D. W.
中科院分区：
文献类型：
--
作者：
McArdle, G. T.;Price, G.;Harkin, D. W.
背景开放性腹主动脉瘤（AAA）修复术与心脏和呼吸系统并发症相关，总体死亡率为2 - 8%。我们假设，在围手术期过多的液体管理有助于并发症和AAA修复后的不良结果。这是一项回顾性队列研究。对2002-2005年期间在一家中心接受开放式AAA修复术的100例连续患者的液体平衡和并发症的医疗记录进行了分析。分析中包括死亡率和所有主要不良事件（MAE），如心肌梗死（MI）、心律失常（Arr）、肺水肿（WO）、肺部感染（PI）和急性肾衰竭（ARF）。护理水平和住院时间也被记录。无院内死亡。401100例患者（40%）发生MAE：MI（6%）; Arr（14%）; PO（14%）; PI（25%）; ARF（8%）。术前心血管危险因素、手术和钳夹时间或失血量不能预测并发症。有并发症的患者在术后第0天（p < 0.01）、第1天（p < 0.05）、第2天（p < 0.03）和第3天（p < 0.04）的累积液体正平衡显著增加。这种关系也存在于个别并发症，如心肌梗死和肺水肿。这些患者的ICU/HDU（p < 0.002）和住院时间（p < 0.0001）显著延长。选择性开放AAA修复术后常见严重并发症，我们已经证明，液体正平衡可预测主要不良事件增加HDU/ICU和总住院时间。(C)2007年欧洲血管外科学会。由爱思唯尔有限公司出版。保留所有权利。
Background. Open abdominal aortic aneurysm (AAA) repair is associated with cardiac and respiratory complications and an overall mortality rate of 2 to 8%. We hypothesised that excessive fluid administration during the perioperative period contributes to complications and poor outcome after AAA repair.Methods. This was a retrospective cohort study. Medical records were analysed for fluid balance and complications in 100 consecutive patients treated by open AAA repair at a single centre between 2002-2005. Mortality and all major adverse events (MAE) such as myocardial infarction (MI), cardiac arrhythmia (Arr), pulmonary oedema WO), pulmonary infection (PI), and acute renal failure (ARF) were included in the analysis. Level of care and hospital stay, were also recorded.Results. There were no in-hospital deaths. MAE occurred in 401100 (40%): MI (6%); Arr (14%); PO (14%); PI (25%); ARF (8%). Complications were not predicted by preoperative cardiovascular risk factors, operative and clamp time, or blood loss. Patients with complications had significantly greater cumulative positive fluid balance on postoperative day 0 (p < 0.01), day 1 (p < 0.05), day 2 (p < 0.03) and day 3 (p < 0.04). This relationship also existed for individual complications such as MI, and pulmonary oedema. These patients had significantly longer ICU/HDU (p < 0.002) and hospital stay (p < 0.0001).Conclusions. Serious complications are common after elective open AAA repair, and we have shown that positive fluid balance is predictive of major adverse events increased HDU/ICU and overall hospital stay. (C) 2007 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.