Abstract：
OBJECTIVE: Although the medical field has made significant progress, there has been little improvement in the survival rate of patients with ruptured abdominal aortic aneurysms (rAAAs). We implemented a protocol consisting of five strategies in the management of rAAA patients who underwent open repair surgery.
METHODS: The protocol comprised the following strategies: intentional hypotension <70 mmHg, lung first and kidney last policy (restricted fluid resuscitation and permissive oligoanuria), immediate postoperative extubation, free-water intake with active ambulation, and open abdomen with the routine second-look operation. The study included 13 patients (11 male) with a mean age of 75.5 ± 7.4 (range: 58-87) years who underwent the procedure from 2016 to 2018, with a mean follow-up of 40.1 ± 9.04 months. Five deteriorating to hemodynamic shock and decreased consciousness requiring intubation and ventilation prior to surgery were observed. Two of these patients required preoperative cardiopulmonary resuscitation (CPR).
RESULTS: All patients regained consciousness after surgery, including the two patients who required cardiopulmonary resuscitation. Immediate postoperative extubation was performed in nine patients, but two (22.2%) of them needed re-intubation due to ventilation/perfusion mismatch. Four patients underwent continuous renal replacement therapy, with three of them having anuria for up to 48 h after surgery. Two of these patients made a full recovery. Daily ambulation was carried out for a mean of 4.77 ± 3.5 (range 1-13) days with an open abdomen, during which no significant events were reported. Four cases of colon ischemia/necrosis were identified in the second-look operation, with two patients requiring Hartman\'s procedure and the other two undergoing left colon partial resection. There were two in-hospital mortalities (15.4%).
CONCLUSIONS: A protocol-based approach, through multidisciplinary team consensus and the development of optimal surgical strategies, could improve clinical outcomes for patients undergoing emergency surgery for rAAA. Further studies with larger sample sizes are needed to refine the protocols.
METHODS: The protocol comprised the following strategies: intentional hypotension <70 mmHg, lung first and kidney last policy (restricted fluid resuscitation and permissive oligoanuria), immediate postoperative extubation, free-water intake with active ambulation, and open abdomen with the routine second-look operation. The study included 13 patients (11 male) with a mean age of 75.5 ± 7.4 (range: 58-87) years who underwent the procedure from 2016 to 2018, with a mean follow-up of 40.1 ± 9.04 months. Five deteriorating to hemodynamic shock and decreased consciousness requiring intubation and ventilation prior to surgery were observed. Two of these patients required preoperative cardiopulmonary resuscitation (CPR).
RESULTS: All patients regained consciousness after surgery, including the two patients who required cardiopulmonary resuscitation. Immediate postoperative extubation was performed in nine patients, but two (22.2%) of them needed re-intubation due to ventilation/perfusion mismatch. Four patients underwent continuous renal replacement therapy, with three of them having anuria for up to 48 h after surgery. Two of these patients made a full recovery. Daily ambulation was carried out for a mean of 4.77 ± 3.5 (range 1-13) days with an open abdomen, during which no significant events were reported. Four cases of colon ischemia/necrosis were identified in the second-look operation, with two patients requiring Hartman\'s procedure and the other two undergoing left colon partial resection. There were two in-hospital mortalities (15.4%).
CONCLUSIONS: A protocol-based approach, through multidisciplinary team consensus and the development of optimal surgical strategies, could improve clinical outcomes for patients undergoing emergency surgery for rAAA. Further studies with larger sample sizes are needed to refine the protocols.
摘要：
目的：尽管医学领域取得了重大进展，腹主动脉瘤破裂（rAAAs）患者的生存率几乎没有改善。我们实施了由五种策略组成的协议，以管理接受开放修复手术的rAAA患者。
方法：该方案包括以下策略：故意低血压<70mmHg，先肺后肾政策（限制性液体复苏和允许少尿症），术后立即拔管,自由饮水，积极行走，并进行常规的二次手术，打开腹部。该研究包括13名患者（11名男性），平均年龄75.5±7.4（范围：58-87）岁，从2016年至2018年接受了该手术，平均随访时间为40.1±9.04个月。观察到五个恶化为血液动力学休克和意识下降，需要在手术前进行插管和通气。其中两名患者需要术前心肺复苏（CPR）。
结果：所有患者术后恢复意识，包括两名需要心肺复苏的患者。术后立即拔管9例，但其中2例(22.2%)因通气/灌注不匹配而需要重新插管.4例患者接受了连续性肾脏替代治疗,其中三人在手术后48小时内出现无尿。其中两名患者完全康复。每日活动进行平均4.77±3.5（范围1-13）天，腹部开放，在此期间未报告重大事件.在二次手术中发现4例结肠缺血/坏死，两名患者需要Hartman手术，另外两名患者接受左结肠部分切除术。有2例住院死亡率（15.4％）。
结论：基于协议的方法，通过多学科团队共识和制定最佳手术策略，可以改善接受rAAA急诊手术的患者的临床结局。需要更大样本量的进一步研究来完善方案。
方法：该方案包括以下策略：故意低血压<70mmHg，先肺后肾政策（限制性液体复苏和允许少尿症），术后立即拔管,自由饮水，积极行走，并进行常规的二次手术，打开腹部。该研究包括13名患者（11名男性），平均年龄75.5±7.4（范围：58-87）岁，从2016年至2018年接受了该手术，平均随访时间为40.1±9.04个月。观察到五个恶化为血液动力学休克和意识下降，需要在手术前进行插管和通气。其中两名患者需要术前心肺复苏（CPR）。
结果：所有患者术后恢复意识，包括两名需要心肺复苏的患者。术后立即拔管9例，但其中2例(22.2%)因通气/灌注不匹配而需要重新插管.4例患者接受了连续性肾脏替代治疗,其中三人在手术后48小时内出现无尿。其中两名患者完全康复。每日活动进行平均4.77±3.5（范围1-13）天，腹部开放，在此期间未报告重大事件.在二次手术中发现4例结肠缺血/坏死，两名患者需要Hartman手术，另外两名患者接受左结肠部分切除术。有2例住院死亡率（15.4％）。
结论：基于协议的方法，通过多学科团队共识和制定最佳手术策略，可以改善接受rAAA急诊手术的患者的临床结局。需要更大样本量的进一步研究来完善方案。
