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腹主动脉瘤患者腔内修复术后再入院预后因素分析

Analysis of prognosis factors for reintervention after endovascular aneurysm repair in patients with abdominal aortic aneurysm

摘要:

目的:探讨腹主动脉瘤患者腔内修复术(EVAR)后再入院的预后因素。方法:回顾性分析2010年1月1日至2017年12月31日在复旦大学附属中山医院血管外科因腹主动脉瘤行EVAR的1 129例患者的临床资料。男性948例,女性181例,年龄(71.2±9.6)岁(范围:18~93岁)。合并原发性高血压630例,糖尿病129例,冠心病163例;有吸烟史214例,既往胸主动脉EVAR 11例。收集患者截至2019年12月31日的随访资料,以再入院为主要终点事件。采用Cox回归进行再入院的预后因素分析。结果:全组患者至少完成1次随访,随访时间22.7(42.6)个月(范围:1~120个月)。术后1年主动脉相关再入院患者占4.52%(51/1 129)。随访期间主动脉相关再入院患者占11.34%(128/1 129),其中88.3%(113/128)为积极再干预。再入院的最主要原因为内漏(60例),其次为髂支闭塞(25例)和髂动脉远端瘤样扩张(12例),其余原因包括瘤体破裂(10例)等。单因素分析结果显示,年龄( HR=0.972,95 %CI:0.956~0.987, P<0.01)、纤维蛋白原高于正常值范围( HR=2.213,95 %CI:1.185~4.134, P=0.013)是患者免于主动脉相关再入院生存时间的预后因素;多因素分析结果显示,术前纤维蛋白原高于正常范围( HR=2.542,95 %CI:1.353~4.776, P=0.004)是患者免于主动脉相关再入院生存时间的独立预后因素。 结论:再入院最主要的原因为内漏,其次为髂支闭塞和远端髂动脉瘤。术前较高的纤维蛋白原水平是EVAR术后患者免于主动脉相关再入院的独立预后因素,其具体机制需进一步研究。

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abstracts:

Objectives:To examine the prognosis factors for readmission after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) patients in the Chinese population.Methods:A total of 1 129 AAA patients who underwent EVAR at Department of Vascular Surgery, Zhongshan Hospital, Fudan University, from January 2010 to December 2017 were enrolled. There were 948 males and 181 females, with an age of (71.2± 9.6) years (range: 8 to 93 years). Comorbidities included primary hypertension found in 630 patients, diabetes mellitus in 129 patients and coronary heart disease in 163 patients. A total of 214 patients had a history of smoking, and 11 patients had a history of previous aortic intervention.Clinical data including baseline information, laboratory examinations and follow-up data before December 31, 2019 were retrospectively collected. The primary end point was readmission. Cox regression analysis was used to analyze the prognosis factors for the end point.Results:All patients completed at least one follow-up with a follow-up time of 22.7(42.6) months (range: 1 to 120 months). The readmission rate of 1 year post-operation was 4.52% (51/1 129). The overall readmission rate was 11.34% (128/1 129) during the whole follow-up duration. The main reasons of readmission included endoleak in 60 patients with readmission, iliac limb occlusion in 25 patients and distal iliac aneurysm in 12 patients. Age ( HR=0.972, 95 %CI: 0.956 to 0.987, P<0.01) and elevated pre-operative fibrinogen level ( HR=2.213, 95 %CI: 1.185 to 4.134, P=0.013) were found to be the prognosis factors for the survival time free from aortic-related readmission in univariate Cox regression analysis. Elevated pre-operative fibrinogen level ( HR=2.542, 95 %CI: 1.353 to 4.776, P=0.004) was found to be the prognosis factor for the survival time free from aortic-related readmission in multivariate Cox regression analysis. Conclusions:The most common reason for readmission was endoleak, followed by iliac limb occlusion and distal iliac aneurysm. Elevated pre-operative fibri nogen level was the risk factor for the survival time free from aortic-related readmission, though further researches were warranted for exploring the underlying mechanism.

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期刊: 《中华外科杂志》2020年58卷11期 E007页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.cn112139-20200625-00490
发布时间: 2020-09-28
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