13例破裂性腹主动脉瘤急诊手术的配合体会

腹主动脉瘤破裂后未手术者100％死亡，而急诊手术治疗的病例死亡率在30％～70％。紧急手术控制出血是关键。而全面的、无疏漏的、紧急而有效的手术配合为手术成功起到了至关重要的作用。1998～2003年1月我院收治破裂性腹主动脉瘤紧急手术患者13例，现将手术配合体会介绍如下。     

13例腹主动脉瘤破裂的急救处理

目的 探讨破裂性腹主动脉瘤及时有效的诊断方法及抢救措施.方法 回顾性分析2002-01～2009-12收治的13例肾动脉下腹主动脉瘤破裂患者的临床资料.临床表现均为腹痛和腰背痛,血压下降或休克,腹部可触及搏动性肿块.所有患者均行开腹止血,腹主动脉瘤切除人工血管植入术.均阻断腹主动脉瘤颈上端的主动脉控制出血,行人工血管重建.结果 术中和术后死亡5 例(38.46%),3例发生急性肾功能不全,3例发生肺部感染,均经相应治疗后痊愈出院.2例术后无并发症,痊愈出院.结论 CTA、多普勒超声等检查适于生命体征相对稳定的疑似病例.开腹手术是治疗破裂腹主动脉瘤的有效方法,手术控制出血和人工血管植入术是挽救生命的有效手段.     

腹主动脉瘤破裂的误诊误治

腹主动脉瘤的主要威胁是突发破裂,病情危重,病死率极高。腹痛、休克、腰背痛、腹部博动性肿块是腹主动脉瘤破裂最常见的表现,螺旋CT、彩超是主要辅助检查手段。腹主动脉瘤破裂症状富于变化,极易引起误诊,误诊疾病包括肾绞痛、胃肠道出血及破裂、肠梗阻、乙状结肠憩室炎、胆囊炎、胰腺炎、嵌顿性腹股沟疝、心肌梗死、腹部钝性外伤等。误诊的主要原因是临床医生对该病不熟悉,思维局限。救治办法是紧急开腹手术切除或行腔内治疗。误诊患者的病死率明显增高,不恰当的辅助检查和术前准备均造成手术延误,错误的手术止血方式也可能导致灾难性的后果。     

腹主动脉瘤破裂误诊分析

腹主动脉瘤（abdominal aortic aneurysms,AAA）临床少见,好发于老年人,其最大的危险是破裂,病死率可达90％,紧急手术治疗的病例病死率也在50％左右,而破裂后未手术者100％死亡。现就我院首例AAA破裂的诊治经过及反思报告如下。     

1例腹主动脉瘤破裂病人的护理

腹主动脉瘤破裂是一种极其危重的外科急症 ,病死率高达5 0 %～ 80 % ,手术存活率仅为 10 %～ 5 0 % [1] 。 2 0 0 1年 5月 31日我院收治 1例腹主动脉瘤破裂病人 ,经手术治疗获得成功 ,现将护理体会介绍如下。1　病例介绍病人 ,女 ,5 1岁。于 2 0 0 1年 5月 31日 14 :0 0因腰部疼痛 2ｈ被收入院。查体 :体温 37.3℃ ,脉搏 12 0 /ｍｉｎ ,呼吸 15 /ｍｉｎ ,血压 10 .67/8.0 0ｋＰａ ,意识不清 ,全身湿冷 ,皮肤苍白 ,脉搏细速 ,双瞳孔等大等圆 ,直径为 0 .3ｃｍ ,对光反应灵敏 ,两肺呼吸音清 ,腹胀、腹部有明显压痛 ,移动性浊音 (+ )。Ｂ超提示…     

外科治疗破裂腹主动脉瘤18例分析

2001—01／2008—03我科收治破裂腹主动脉瘤（RAAA）18例，分析如下。     

腹主动脉瘤破裂急救手术的护理配合

腹主动脉瘤破裂（Ruptured abdomin alarotic aneurysm,RAAA）是血管外科最为凶险的疾病之一,如不及时修复,患者24h内生存率〈50%,总死亡率达到85%~95%[1]。开腹手术是治疗RAAA快速而有效的方法,而全面的、无疏漏的、紧急的手术配合,对手术成功起到了至关重要的作用。     

马凡综合征并发腹主动脉瘤破裂

【病例】女,28岁,孕3产0。因左侧中下腹痛伴恶心、呕吐16小时入院。平素月经规律,末次月经为入院前15天。患者3年前因马凡综合征二尖瓣关闭不全行心脏瓣膜置换术。查体:脉搏114/m in,呼吸24/m in,血压75/55 mmHg,身高180 cm。贫血貌,精神萎靡,四肢湿冷,长头,鸡胸,双肺呼吸音清晰,心率114/m in,律齐,各瓣膜听诊区未闻及病理性杂音。腹平坦,未见胃肠型及蠕动波,下腹腹肌紧张,压痛,反跳痛,以左下腹为著,左下腹叩诊呈浊音,移动性浊音阴性,肠鸣音3/m in。脊柱无畸形,四肢长,手指细长。妇科检查:已婚未产型外阴,阴道通畅,宫颈着色不明显,有举痛及…     

巨大腹主动脉瘤破裂一例误诊

【病例】男,78岁。因突发全腹痛7小时,头晕、心悸3小时入院。入院前7小时突发全腹胀痛,后转为持续性锐痛,伴恶心,无反酸、嗳气及腹泻。3小时前出现心悸、气短、头晕、面色苍白,在外院就诊,测血压80/30 mmHg,予多巴胺维持血压并快速补液,急转我院。既往史:2年前确诊为冠心病。查     

Endovascular versus open repair of ruptured abdominal aortic aneurysms

Although major improvement has occurred to make elective repair of abdominal aortic aneurysms a safe procedure, the incidence of ruptured abdominal aortic aneurysms and mortality rates are still disappointing. Endovascular abdominal aortic aneurysm repair has produced quantum changes in aneurysm treatment. The successful application of the endovascular approach for the treatment of abdominal aortic aneurysms in the elective setting has prompted a strong interest regarding its possible use in dealing with the long-standing challenge of a ruptured abdominal aortic aneurysm. Since the first report, several centers have reported results and a wide spectrum of opinion regarding its application, with special consideration to logistical and practical barriers for appropriate utilization. The purpose of this article is to review all the available literature on the endovascular repair of ruptured abdominal aortic aneurysms and to analyze the most recent trends in their management, with special consideration given to comparing results of conventional and endovascular approaches.     

外科手术在腹主动脉瘤治疗中的地位

目的探讨并评价外科手术在腹主动脉瘤治疗中的地位和安全性。方法作者两所医院75例腹主动脉瘤患者，26例行外科手术腹主动脉瘤切除人工血管移植术，49例腔内治疗。分析2组的手术并发症、病死率、住院时间及住院费用。结果3例急诊外科手术患者2例死亡，其余择期外科手术及腔内治疗的患者均成功，无死亡，住院时间腔内治疗明显短于外科手术治疗，住院费用外科手术明显低于腔内治疗组。结论外科手术仍是目前治疗腹主动脉瘤的主要方法，是一种安全、经济有效、可普及的治疗手段。腔内治疗有它的特殊性，是微创外科发展的趋势。     

Emerging strategies to treat ruptured abdominal aortic aneurysms

Population screening programmes and a falling population prevalence of smoking have led to a declining incidence of ruptured abdominal aortic aneurysms in men. However, ruptured abdominal aortic aneurysms remain a common vascular surgical emergency, with an increasing proportion of ruptures being in women. About one quarter of the ruptures have a juxta-renal aneurysm and are more challenging to repair using endovascular technologies. Endovascular technologies may not reduce the overall mortality, compared with open surgical repair, but appear to offer early benefits with respect to patient quality of life at acceptable cost. Challenges over the next 5 years include widening the access to repair, developing an accurate bedside risk scoring tool, as well as optimising strategies for pre-operative resuscitation, standardising peri-operative care and the management of post-operative complications.     

腔内修复术治疗破裂性腹主动脉瘤的疗效及技巧探讨

目的观察腔内修复术(EVAR)治疗破裂性腹主动脉瘤(RAAA)的疗效,并探讨手术经验与技巧。方法 2009年1月—2013年12月收治的RAAA患者12例,均于全身麻醉后行EVAR,经一侧股动脉穿刺置管造影,沿肾动脉下方通过输送器植入支架。结果 12例患者中,8例(66.67%)植入分叉型人工血管内支架,4例(33.33%)植入直型支架;平均手术时间(170.35±15.34)min,平均出血量和输血量分别为(92.55±8.67)m L和(301.58±16.39)m L。术中无死亡病例,术后2例(16.67%)死亡;主要并发症为心律失常、肺部感染、肾功能损害等,并发症总发生率58.33%;1例(10.00%)患者于术后26个月出现Ⅰa型内漏,再次行栓塞治疗。结论 EVAR是RAAA的有效救治方式,术前血管造影检查对保证手术效果至关重要。     

Strain estimation in abdominal aortic aneurysms from 2-D ultrasound

The rupture risk of abdominal aortic aneurysms (AAAs) is routinely inferred from the maximum diameter of the AAA. However, clinical experience indicates that this criterion has poor accuracy and that noninvasive assessment of the elastic properties of the vessel might give better correspondence with the rupture risk. We have developed a method for analysis of circumferential strain in AAAs from sequences of cross-sectional ultrasound B-mode images. The algorithm is fast, semiautomatic and well-suited for real-time applications. The method was developed and evaluated using data from 10 AAA patients. The preliminary results demonstrate that the method is sufficiently accurate and robust for clinically acquired data. An important finding is that local strain values may exceed the circumferential average strain significantly. Furthermore, the calculated strain shows no apparent covariation with the diagnosed diameter. This implies that the method may give new and essential information on the clinical condition of the AAA.     

Chlamydia pneumoniae reactive T lymphocytes in the walls of abdominal aortic aneurysms.

BACKGROUND: The presence of Chlamydia pneumoniae in the walls of abdominal aortic aneurysms (AAAs) has been demonstrated recently, but its role in the cause and/or maintenance of aortic wall inflammation is not known. In the present study, we have investigated the possible relationship between C. pneumoniae and the antigen specificity of T lymphocytes mediating inflammation in AAA tissue. MATERIALS AND METHODS: Tissue specimens were obtained from 22 consecutive AAA patients undergoing elective surgery (mean age 67 +/- 1 year). Immunohistochemical analysis of the formalin-fixed tissue was performed using the streptavidin-biotin-peroxidase method. In vivo activated T lymphocytes were propagated from the specimens with interleukin (IL) 2, and antigen specificity of the established T-cell lines was analysed in the presence of autologous antigen-presenting cells using radioactive thymidine labelling. RESULTS: Immunohistological staining of AAA tissue showed the presence of C. pneumoniae antigen in 55% (6/11) of the samples studied. The inflammatory cell infiltrate of the AAA tissue contained 60-90% T (CD45RO) and 0-10% B (CD20) cells. When the tissue specimens were cultured without antigen in the presence of IL-2, lymphocyte propagation was achieved in 17 out of the 22 samples. Chlamydia pneumoniae antigen was found to induce a positive proliferative response in 8 of the 17 lines. CONCLUSIONS: The presence of C. pneumoniae specific T lymphocytes among in vivo activated cells from the AAA tissue specimens suggests that C. pneumoniae participates in the maintenance of the inflammatory response in the tissue and may thus be involved in the progression of the disease.     

腹主动脉瘤围手术期的护理观察

目的 总结腹主动脉瘤（AAA）围手术期的护理的经验与教训。方法 对1995年6月～2005年6月经外科治疗的腹主动脉瘤42例围手术期临床观察的资料进行回顾性分析总结。结果 2例术前24h瘤体破裂死亡，1例术后出血，2例发生肠梗阻．经度时治疗痊愈。无并发症发生。结论 提示AAA围手术期应严密观察患者的心率、血压、腹部情况，并针对性预防并发症。针对患者疾病的特点，采取适宜的护理措施是保证患者手术成功的关健。     

腹主动脉瘤破裂的预后影响因素分析

目的 探讨影响腹主动脉瘤破裂的预后影响因素.方法 回顾性分析中山大学附属第一医院自1980年1月至2013年5月间收治的85例破裂型腹主动脉瘤患者的临床资料.从腹主动脉瘤破裂的疾病相关因素和手术相关因素两方面进行研究,采用单因素分析和Logistic多元回归分析了解影响腹主动脉瘤破裂患者的预后影响因素.结果 67例行手术治疗,术后30 d病死率为35.8％.围手术期病死率为47.6％,抢救成功率为52.4％.通过单因素分析可知在腹主动脉瘤破裂的疾病相关因素中,年龄(P=0.012)、从发病到就诊时间(P=0.023)、合并冠状动脉粥样硬化性心脏病(P=0.041)或慢性阻塞性肺疾病(P=0.018)、心搏骤停(P =0.036)、休克持续时间(P =0.007)和就诊时收缩压(P=0.015)在死亡组与存活组间差异有统计学意义;手术相关因素中,从就诊到手术开始时间(P=0.001)、手术时间(P =0.024)、失血量(P =0.039)及主动脉阻断时间(P=0.030)于两组间差异有统计学意义.通过多因素分析显示年龄(P=0.049)、合并冠状动脉粥样硬化性心脏病(P=0.016)、休克持续时间(P =0.007)、从就诊到手术开始时间(P =0.025)、手术时间(P=0.041)及失血量(P=0.021)于两组间差异有统计学意义.结论 腹主动脉瘤破裂病情进展迅猛,病死率高,临床上应力求早期诊断,及时手术治疗控制出血,才能提高其存活率.     

Endovascular repair of abdominal aortic aneurysms: CTA evaluation of contraindications

Endovascular aortic aneurysm repair (EVAR) is considered an acceptable alternative to open surgery in selected patients. Its feasibility depends mainly on anatomic factors that represent the important predictors of success and the most important exclusion criteria. Poor anatomic patient selection is generally associated with a higher risk for procedural complications and compromised long-term outcomes. Therefore pretreatment imaging is crucial for evaluating patient suitability for EVAR. Multidetector computed tomographic angiography represents the current standard of reference in the evaluation of the abdominal aorta and iliac axis anatomy because it provides all the details needed for selection of patients who are suitable for endograft and the choice of the appropriate device. This report identifies and reviews computed tomographic angiographic anatomic contraindications for EVAR.