目的:评价胸主动脉腔内修复术(TEVAR)治疗闭合性胸主动脉损伤(BTAI)的时机与预后的关系。
方法:这是一项单中心回顾性队列研究。从2016年10月至2023年9月在我们机构接受TEVAR进行BTAI的患者根据损伤严重程度评分(ISS)分为2类(≤25vs.>25)以及当BTAI进行TEVAR时(在24小时内vs.24小时后),分别。分析包括通过全身CT血管造影诊断为BTAI后接受TEVAR治疗的所有患者。接受开放修复和非手术治疗的患者被排除在外。在对各种因素进行倾向得分匹配后,比较住院期间和随访期间的结局.这些因素包括人口统计,合并症,伴随的伤害,主动脉损伤的原因和位置,格拉斯哥昏迷量表评分,血管外科学会分级,血红蛋白浓度,肌酐浓度,震惊,收缩压,入院时的心率。使用SPSS26软件进行比较。连续变量表示为平均值±标准偏差或中位数(Q1,Q3),并使用t检验或曼-惠特尼U检验进行比较。分类变量表示为n(%),并使用χ2检验或Fisher精确检验在两组之间进行比较。统计显著性定义为双侧p<0.05。
结果:总计,110名患者参与了这项研究,65例(59.1%)ISS评分>25和32例(29.1%)患者立即接受TEVAR。ISS>25组围手术期总死亡率明显高于ISS≤25组(11(16.9%)vs.2(4.4%),p<0.001)。一被录取,与直接组相比,选择性组表现出明显更高的格拉斯哥昏迷评分(中位数(Q1,Q3))(15(12,15)与13.5(9,15),p=0.039),而入院时的肌酐浓度(中位数(Q1,Q3))在立即组(90.5(63.8,144.0)与71.5(58.3,80.8),p=0.012)。最终样本包括52名匹配的患者。与直接组相比,选择性组的并发症发生率明显较低(16(50.0%)与3(10.0%),p<0.001)。单因素方差分析显示,住院患者并发症显著相关,即刻TEVAR为唯一独立危险因素(比值比:9.000,95%置信区间:2.266-35.752,p=0.002)。
结论:在接受TEVAR治疗BTAI的患者的倾向评分匹配分析中,选择性TEVAR与较低的并发症发生率显著相关.在这项使用倾向得分匹配的研究中,接受选择性TEVAR治疗BTAI的患者并发症发生率低于即时TEVAR.
OBJECTIVE: To evaluate the relationship between the timing of thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) and prognosis.
METHODS: This is a single-center retrospective cohort study. Patients who received TEVAR for BTAI at our institution from October 2016 to September 2023 were divided into 2 categories depending on the injury severity score (ISS) (≤ 25 vs. > 25) and when the TEVAR was performed for BTAI (within 24 h vs. after 24 h), respectively. The analysis included all patients who received TEVAR treatment after being diagnosed with BTAI through whole-body CT angiography. Patients treated with open repair and non-operative management were excluded. After propensity-score matching for various factors, outcomes during hospitalization and follow-up were compared. These factors included demographics, comorbidities, concomitant injuries, cause and location of aortic injury, Glasgow coma scale score, society for vascular surgery grading, hemoglobin concentration, creatinine concentration, shock, systolic blood pressure, and heart rate at admission. The comparison was conducted using SPSS 26 software. Continuous variables were presented as either the mean ± standard deviation or median (Q1, Q3), and were compared using either the t-test or the Mann-Whitney U test. Categorical variables were expressed as n (%), and comparisons were made between the 2 groups using the χ2 test or Fisher\'s exact test. Statistical significance was defined as a 2-sided p < 0.05.
RESULTS: In total, 110 patients were involved in the study, with 65 (59.1%) patients having ISS scores > 25 and 32 (29.1%) receiving immediate TEVAR. The perioperative overall mortality rate in the group with ISS > 25 was significantly higher than that in the group with ISS ≤ 25 (11 (16.9%) vs. 2 (4.4%), p < 0.001). Upon admission, the elective group exhibited a notably higher Glasgow coma scale score (median (Q1, Q3)) compared to the immediate group (15 (12, 15) vs. 13.5 (9, 15), p = 0.039), while the creatinine concentration (median (Q1, Q3)) at admission was significantly higher in the immediate group (90.5 (63.8, 144.0) vs. 71.5 (58.3, 80.8), p = 0.012). The final sample included 52 matched patients. Complications occurred significantly less frequently in the elective group compared to the immediate group (16 (50.0%) vs. 3 (10.0%), p < 0.001). Single-factor analysis of variance showed that complications in hospitalized patients were significantly associated with immediate TEVAR as the sole independent risk factor (odds ratio: 9.000, 95% confidence interval: 2.266 - 35.752, p = 0.002).
CONCLUSIONS: In this propensity-score matched analysis of patients undergoing TEVAR for BTAI, elective TEVAR was significantly associated with a lower risk of complication rates. In this study using propensity-score matching, patients who underwent elective TEVAR for BTAI had lower complication rates than immediate TEVAR.