Pulmonary complications after descending thoracic and thoracoabdominal aortic aneurysm repair: Predictors, prevention, and treatment
Pulmonary complications after descending thoracic and thoracoabdominal aortic aneurysm repair: Predictors, prevention, and treatment
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DOI：
10.1016/j.athoracsur.2006.10.099
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发表时间：
2007-02-01
影响因子：
4.6
通讯作者：
Plestis, Konstadinos A.
中科院分区：
文献类型：
--
作者：
Etz, Christian D.;Di Luozzo, Gabriele;Plestis, Konstadinos A.
背景。尽管最近外科技术的进步改善了降胸（DTA）和胸腹主动脉瘤（TAAA）修复的效果，但仍然存在显著的死亡率和发病率。本回顾性研究的目的是确定术后肺部并发症和延长住院时间的预测因素。219例患者（年龄中位数66岁，范围18 ~ 88岁，男性112例）行DTA （n = 79[36%； 23例象鼻吻合术]）或TAAA (n = 140 [64%]), Crawford I (52%), II (10%), III (11%), IV (7%)；在2002年6月至2005年6月期间完成了31个象鼻工程])。41例患者出现动脉瘤破裂。51%的患者采用左心房-股动脉旁路术。41%的患者采用股股旁路和远端主动脉灌注，43例患者采用深度低温循环停搏（DHCA）（平均持续时间：31 +/- 9分钟）；8%采用夹缝技术。不良结局21例（9.5%）；医院死亡13例（5.9%），中风13例（其中5例死亡，5.9%）。60例患者（27%）出现呼吸系统并发症，术后通气时间延长（超过48小时）；24例（11%）需要气管切开术。DTA/TAAA术后肺部并发症的独立预测因子为TAAA （p = 0.03）、术前血尿素氮> 24 mg/dL （p = 0.03）和肺破裂（p = 0.09）。住院时间中位数为11天（四分位数范围为6至35天）。住院时间的独立预测因子为术前血尿素氮（p = 0.045）、术后出血（p < 0.005）、再插管（p = 0.001）、气管造口术（p < 0.0005）和血小板输注（p = 0.008）。这一当代经验表明，术前肾功能不全和大面积动脉瘤是主动脉瘤手术后呼吸并发症的重要预测因素。
Background. Although recent advances in surgical techniques have improved outcomes of descending thoracic (DTA) and thoracoabdominal aortic aneurysm (TAAA) repair, significant mortality and morbidity still occur. The aim of the current retrospective study is to determine predictors of postoperative pulmonary complications and prolonged hospital stay.Methods. Two hundred nineteen patients (median age, 66 years; range, 18 to 88; 112 male) underwent DTA (n = 79 [36%; 23 elephant trunk completions]) or TAAA (n = 140 [64%; Crawford I (52%), II (10%), III (11%), IV (7%); 31 elephant trunk completions]) between June 2002 and June 2005. Forty-one patients presented with ruptured aneurysms. Left atrial-to-femoral bypass was utilized in 51% of the patients. Femoro-femoral bypass and distal aortic perfusion were used in 41% of the patients, deep hypothermic circulatory arrest (DHCA) was used in 43 patients (mean duration: 31 +/- 9 minutes); 8% were done with clamp- and-sew technique.Results. Adverse outcomes were seen in 21 patients (9.5%); hospital death in 13 (5.9%), and stroke in 13 (5 of whom died; 5.9%). Sixty patients (27%) experienced respiratory complications with prolonged postoperative ventilation (longer than 48 hours); 24 required tracheostomy (11%). Independent predictors of pulmonary complications after DTA/TAAA were TAAA (p = 0.03), preoperative blood urea nitrogen greater than 24 mg/dL (p = 0.03) and rupture (p =s 0.09). The median hospital stay was 11 days (interquartile range, 6 to 35). Independent predictors of length of hospital stay were preoperative blood urea nitrogen (p = 0.045), postoperative bleeding (p < 0.005), reintubation (p = 0.001), tracheostomy (p < 0.0005), and transfusion of platelets (p = 0.008).Conclusions. This contemporary experience demonstrates that preoperative renal insufficiency and extensive aneurysm are important predictors of respiratory complications after aortic aneurysm surgery.