- 期刊
Acutely Ruptured Abdominal Aortic Aneurysm: Experience in Chi Mei Hospital
急性腹腔主動脈瘤破裂：台南奇美醫院的經驗
摘要
急性腹腔主動脈瘤破裂的手術死亡率約是40-50%。如何有效治療、降低死亡率，是臨床醫師一大挑戰。本篇研究的主要目的是藉本院治療的經驗，探討這疾病在南台灣的情況，及分析成功治療的可能原因。 從1995到2001年，共有16位患者被診斷為這疾病並接受手術。在這之前沒有任何患者知道自己有腹腔主動脈瘤，平常沒有症狀。腹痛或下背痛是急性破裂後最常見的臨床表徵。男性佔大多數，有13位，女性只有3位；年齡從52到84歲，平均68.3歲；從症狀發作到醫院求診的平均時間是7小時，從醫院求診到手術的平均時間是3.5小時；4位患者死亡，住院死亡率25%；其中2位死於手術過程，2位在手術後死於多器官衰竭。 術中及術後第一天的尿量，傳達病患休克程度及預後好壞。手術是此病治療的唯一希望，急診室第一線醫師對此病保持高度警覺，儘早診斷。心臟血管醫師在診斷之後儘早手術，以避免或儘可能縮小重要器官受到缺血性傷害的程度，是獲致良好結果的重要因素。
關鍵字
無資料並列摘要
Objectives: The aim of this study was to identify the clinical features of, and analyze the cause of successful operative therapy in, patients with acutely ruptured abdominal aortic aneurysm (AAA) in southern Taiwan. Methods: Patients with an acutely ruptured AAA who reached hospital alive between 1995 and 2001 were selected and analyzed retrospectively. Results: Sixteen patients with an acutely ruptured AAA were identified and operated on. None had a known history of AAA. Abdominal pain and lower back pain are the two most common manifestations. There were thirteen men and three women. The mean age was 68.3 years (range: 52-84). The mean urine output during the operation and day one after the operation were 2.3±1.7 ml/minute and 1106±434 ml/24 hours, respectively. The median interval between symptom onset and hospitalization was seven hours, and that between hospitalization and operation was three and a half hours. Four patients died during hospitalization (hospital mortality rate: 25%). Of them, two patients died of hypovolemic shock during the operation and the other two died of multiple organ failure (MOF) 34 and 93 days after the operation respectively. Conclusions: The urine output could herald the severity of shock and imply the prognosis. Rapid diagnosis, appropriate resuscitation, and operation without any delay to minimize the extent of ischemic damage to vital organs could prevent postoperative MOF and decrease postoperative death. To control bleeding immediately after exploration for avoiding intraoperative hypovolemic shock could decrease intraoperative death.