Rüptüre Abdominal Aort Anevrizmasında Zamanla Yarış: Hayatta Kalma ve Tedavi Sonuçlarının Retrospektif Analizi

Year 2024, Volume: 8 Issue: 3, 355 - 362, 30.12.2024

Ali Kemal Gür , Oğuz Arslantürk

Abstract

Amaç: Rüptüre abdominal aort anevrizmaları (rAAA) operasyon öncesi ve sonrası yüksek mortaliteye sahip acil cerrahi bir durumdur. Bu
çalışmanın amacı acil cerrahi tedavi edilen infrarenal abdominal aort anevrizmalarında operasyon öncesi, sırası ve sonrası mortaliteye etki
eden faktörlerin araştırılmasıdır
Gereç ve Yöntemler: Abdominal aort anevrizma rüptürü tanısı ile 2019-2024 yılları arasında acil ve açık cerrahi ile opere edilen 38 hasta
[erkek 34(%89,4), kadın 4(%10,6)] çalışmaya alınmıştır. Hastaların operasyon öncesi ve operasyon sonrası demografik özellikleri retrospektif
olarak incelenmiştir. Semptomların başlamasından sonra tedavi amaçlı gidilen hastanelere göre hastalar iki gruba ayrıldı. Acil servisimize
başvuran veya ambulans ile getirilen hastalar Grup-1 (n=17) ve dış merkezlerden tanı konulup tarafımıza refere edilen hastalar Grup-2
(n=21) olarak ayrıldılar.
Bulgular: Çalışmaya alınan 38 hastanın yaş ortalaması 63,57 ± 13,62 yıldı. Hastaların 34’ü erkek ve dördü kadındı. Eşlik eden risk faktörleri
kronik obstrüktif akciğer hastalığı (n=17, %50), diyabet (n=25, %65,7), hipertansiyon (n=33, %86,8), hiperlipidemi (n=35, %92,1) ve akut
böbrek yetersizliği (n=4, %10,5) idi. Toplam 9 (%23,6) hasta kaybedildi. Mortal seyreden hastaların hepsi yoğun bakım takipleri sırasında
(10 ± 9,6 gün) kaybedildi. Hastanemiz bölgeye hitap etmesi nedeniyle çevre illerden sevk edilen hastalarda mortalite daha yüksek görüldü.
Dokuz hastanın yedisi dış merkezde tanı konularak sevk edilen hastalardı. Mortalite sebepleri renal yetersizlik, multiorgan yetersizliği,
respiratuvar distrest sendromu ve sepsis olarak görüldü.
Sonuç: Karın ağrısı nedeniyle acil servise başvuran hastaların rAAA tanısı konulduktan sonra mümkün olan en kısa sürede opere edildiğinde
ölüm oranlarında önemli oranda azalma görülmektedir. Hipotansiyon, yüksek üre ve kreatinin seviyeleri, kan kaybı, yetersiz kan ve mayi
verilmesi, bilinç kaybı, kardiyak arrest operasyon öncesi mortaliteyi arttırıcı nedenlerdir. Kısa süren aortik kross klemp süresi, intraoperatif
kan kaybının minimum seviyeye indirilmesi, hastaları operasyon sırasında düşük tansiyondan korumak ve iyi bir diürez ile sağ kalım oranı
yükselmektedir.

Keywords

Rüptüre abdominal aort anevrizmaları, mortalite, zaman

Race Over Time in Ruptured Abdominal Aortic Aneurysm: A Retrospective Analysis of Survival and Treatment Outcomes

Abstract

Aim: Ruptured abdominal aortic aneurysms (rAAA) are a surgical emergency with high pre- and postoperative mortality. The aim of this
study was to investigate the factors affecting preoperative, intraoperative and postoperative mortality in infrarenal abdominal aortic aneurysms
treated with emergency surgery.
Material and Methods: Thirty-eight patients [male 34 (89.4%), female 4 (10.6%)] who underwent emergency and open surgery for ruptured
abdominal aortic aneurysm between 2019 and 2024 were included in the study. Preoperative and postoperative demographic characteristics
of the patients were retrospectively analyzed. Patients were divided into two groups according to the hospitals visited for treatment after the
onset of symptoms. Patients admitted to our emergency department or brought by ambulance were divided into Group-1 (n=17) and patients
diagnosed from external centers and consulted to us were divided into Group-2 (n=21).
Results: The mean age of the 38 patients included in the study was 63.57 ± 13.62 years. 34 of the patients were male (89.4%) and four were
female (10.6%). Concomitant risk factors were chronic obstructive pulmonary disease (n=17, 50%), diabetes (n=25, 65.7%), hypertension (n=33, 86.8%), hyperlipidemia (n=35, 92.1%) and acute renal failure (n=4, 10.5%). A total of 9 (23.6%) patients died. All mortal patients died
during intensive care unit follow-up (10 ± 9.6 days). Since our hospital is located in the region, mortality was higher in patients referred from
neighboring provinces. Of the nine patients, seven were referred after being diagnosed in an external center. The causes of mortality were
renal failure, multiorgan failure, respiratory distress syndrome and sepsis.
Conclusion: When patients presenting to the emergency department with abdominal pain are operated as soon as possible after the
diagnosis of rAAA, there is a significant reduction in motrality rates. Hypotension, high urea and creatinine levels, blood loss, inadequate
blood and fluid administration, loss of consciousness, cardiac arrest are the causes of increased preoperative mortality. Short duration of
aortic cross-clamping, minimizing intraoperative blood loss, protecting patients from low blood pressure during the operation and good
diuresis increase the survival rate.

Keywords

Ruptured abdominal aortic aneurysms, mortality, time

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