A型主动脉夹层术后脊髓缺血性损伤的病例特征  

The Clinical Characteristics of Spinal Cord Ischemia After Surgical Repair for Type A Aortic Dissection

作　　者：楚军民[1] 卫金花[1] 张海涛[1] 常谦[1] 

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外医院心外科,北京市100037

出　　处：《中国分子心脏病学杂志》2016年第2期1640-1642,共3页Molecular Cardiology of China

摘　　要：目的分析A型主动脉夹层术后脊髓缺血性损伤(spinal cord ischemie,SCI)的病例资料,探讨围手术期发生SCI的病例特征,为SCI的治疗及预后提供临床依据。方法自2014年1月至2015年12月,330例A型主动脉夹层接受手术治疗,术后出现脊髓缺血损伤19例。根据是否合并其他严重并发症分为两组,13例单纯SCI患者(单纯组)和6例合并两种或多种并发症患者(复合组)。分析比较每组的临床资料、影像学表现、术中情况、术后及随访情况。结果 A型主动脉夹层术后SCI发生率为5.79%。单纯组中5例患者存在无名动脉和左颈总动脉受夹层累及,而复合组全部6例均存在无名动脉和左颈总动脉受累(P<O.0s)。左锁骨下动脉受累发生率在两组中均较高,其中单纯组中11例患者受累,发生率为86.7%;复合组中6例均受累(P>O.05)。两组患者胸段肋间动脉均严重受累,发自假腔肋间动脉平均为15.77±2.51支和15.5±4.82支,两组间比较无差异。单纯组患者体外循环时间,主动脉阻断时间及深低温停循环时间均低于复合组,但无统计学差异(P>0.05)。单纯组患者ICU治疗时间及呼吸机使用时间均显著低于复合组(P<O.05)。单纯组中11例患者接受脑脊液引流治疗,12例缺血症状明显缓解;复合组中3例患者行脑脊液引流治疗,其中2例患者症状缓解。结论 A型主动脉夹层术后发生SCI患者,术前多伴有严重的左锁骨下动脉和胸段肋间动脉受累。复合组患者较单纯SCI患者无名动脉和左颈总动脉受累更严重。复合组SCI患者术中体外循环时间、主动脉阻断时间、深低温停循环时间偏长,其呼吸机使用时间及ICU住院时间均明显延长。单纯SCI患者脊髓缺血症状大多可有效缓解,预后较好。Objective through analyzing the clinical data of patients with spinal cord ischemia（SCI） after surgical repair for type A aortic dissection.To review the characteristics of the patients and provide the clinical evidence for treatment and prognosis.Methods From January2014 to December 2015,330 patients with type A aortic dissection underwent surgical procedure,19 cases was found with postoperative SCI.All 19 patients were divided into two groups according whether combined other more serious complications,including 13 cases with isolated SCI（single group） and 6 cases with more than one postoperative complications（compound group）.The clinical data of these patients was collected and analyzed.Results The incidence of SCI after surgical repair for type A aortic dissection was 5.79%.All 6 cases in the compound group and 5 cases in the single group was found with involvement of innominate artery and left common carotid artery（P 〈0.05）.The rate of involvement of left subclavian was found to be equally high in both groups（84.6%in the single group and 100%in the compound group,P 〈0.05）.The involvement of intercostals artery was demonstrated to be severe in both groups.The mean number of intercostals artery involved by the dissection was 15.77±2.51 in the single group and 15.5＊4.82 in the compound group（P 〈0.05）.The bypass time,aortic block time,and deep hypothermic circulatory arrest time of single group were lower than the compound group,however,the difference was not significant（P 〈0.05）.The time of stay-in ICU and mechanical ventilation of single group were significantly lower than the compound group（P 〈0.05）.Cerebrospinal fluid drainage treatment was performed in 11 cases in the single group and 3 cases in compound group：and SCI symptoms was relieved in 12 cases in the single group and 2 cases in compound group.Conclusion The involvement of left subclavian artery and intercostal arteries are commonly in SCI patients before surgical repair for type A aortic dissection.The e

关 键 词：A型主动脉夹层 脊髓缺血性损伤 左锁骨下动脉 肋间动脉 脑脊液引流 

分 类 号：R654.3[医药卫生—外科学] R651.2[医药卫生—临床医学]