全胸腹主动脉置换术后脊髓缺血的临床分析  

Ananlysis of the spinal cord ischemia in patients underwent total thoracoabdominal aortic aneurysm repair

作　　者：陈菲[1] 邵涓涓[1] 贾明[1] 黄连军[2] 孙立忠[3] 侯晓彤[1] 

机构地区：[1]首都医科大学附属北京安贞医院-心肺血管疾病研究所心脏外科危重症中心,100029 [2]首都医科大学附属北京安贞医院-心肺血管疾病研究所介入诊疗科,100029 [3]首都医科大学附属北京安贞医院-心肺血管疾病研究所心外科,100029

出　　处：《心肺血管病杂志》2015年第9期694-697,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:分析全胸腹主动脉置换术(total thoracoabdominal aortic aneurysm repair,t TAAAR)后出现脊髓缺血(spinal cord ischemia,SCI)患者的临床特点、危险因素及治疗经验。方法:回顾性分析北京安贞医院于2012年1月至2013年2月间,常温、非体外循环下行t TAAAR治疗患者的临床资料,共31例(男性20例,女性11例),平均年龄(38±12)岁。患者均为Crawford II型胸腹主动脉瘤,其中Stanford A型夹层5例,Stanford B型夹层20例,真性动脉瘤6例。结果:t TAAAR手术成功率100%,围术期病死率3.2%。术后随访1年,出现脊髓缺血7例(22.6%),经过积极的激素冲击、甘露醇脱水、脑脊液引流等治疗后,4例(12.9%)下肢轻瘫患者完全恢复,3例(9.7%)截瘫患者进一步改善。结论:脊髓缺血是t TAAAR术后严重并发症,加强围术期的脊髓保护,监测脑脊液压力,并进行积极的对症治疗,能有效减少其发生率。Objective：To analysisthe characteristics and risk factors of spinal cord ischemia （SCI）in patients underwent total thoracoabdominal aortic aneutysm repair （tTAAAR） and to summarize our experience. Methods：Clinical data of 31 patients [20 cases were male, average age of （38 ± 12） years old] underwent tTAAAR at room temperature without CPB in aortic center of Anzhen hospital from January 2012 to February 2013 were retrospectively reviewed, All cases were Crawford type II thoracoabdominal aortic aneurysm patients, including 5 cases of Stanford type A aortic dissection, 20 cases of Stanford type B dissection and 6 casesof true aneurysm. Results： The procedural success rate of tTAAARwas 100%, perioperative mortality rate was 3.2%. Postoperative SCI occurredin 7 cases （22. 6% ） , under the treatment of glucocorticoid andmannitol, cerebrospi- nal fluid drainage, eet, 4 cases （ 12.9% ） withparaparesis were completely recovered, 3 cases （ 9. 7% ） with paraplegia needed further treatment. Conclusion： SCI is one of serious complications after tTAAAR. Periopera- tive spinal cord protection, monitoring of cerebrospinal fluid pressure, and active intervention could effectively reduce the incidence of SCI.

关 键 词：全胸腹主动脉替换术 脊髓缺血 胸腹主动脉瘤 主动脉夹层 

分 类 号：R54[医药卫生—心血管疾病]