规范化综合性脊髓保护措施能够降低主动脉手术患者围手术期脊髓损伤发生率:8年回顾性分析  

Standardized multidisciplinary spinal cord protection strategies reduce spinal cord injury during perioperative period of aortic surgery:an 8-year retrospective analysis

作　　者：周宏艳[1] 王冀[1] 袁素[2] 于存涛[3] 钱向阳[3] 孙晓刚[3] 陈祖君[1] 张海涛[1] Zhou Hongyan;Wang Ji;Yuan Su;Yu Cuntao;Qian Xiangyang;Sun Xiaogang;Chen Zujun;Zhang Haitao(Department of Cardiac Surgery ICU,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Anesthesia,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiac Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心脏外科ICU,北京100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院麻醉中心,北京100037 [3]中国医学科学院北京协和医学院国家心血管病中心阜外医院心脏外科,北京100037

出　　处：《中华危重病急救医学》2019年第5期633-636,共4页Chinese Critical Care Medicine

基　　金：北京市科技计划项目(D171100002917004).

摘　　要：目的观察中国医学科学院阜外医院8年间主动脉手术术后脊髓损伤(SCI)的发生情况以及规范化综合性脊髓保护措施的效果,为主动脉手术围手术期SCI防治总结相关经验。方法回顾性分析2011年1月至2018年12月阜外医院血管中心完成主动脉手术患者的临床资料,其中2011年1月至2016年12月接受传统脊髓保护管理流程的患者作为对照组;2017年1月至2018年12月接受规范化综合性脊髓保护措施的患者作为规范化治疗组,包括预防性脑脊液引流(CSFD)、呼吸道管理、维持有效循环的最低静脉压,同时启动抗凝、糖皮质激素、改善微循环、清除氧自由基等辅助治疗,并监测神经功能,预防并发症。观察开展围手术期规范化综合性脊髓保护措施前后主动脉手术后SCI发生率的变化,评价规范化综合性脊髓保护措施的效果;同时对术后SCI的类型以及CSFD的安全性进行分析。结果8年间阜外医院血管中心共完成主动脉手术7 724例,术后出现SCI患者64例,总体发生率为0.83%;其中速发型SCI 39例(60.94%),迟发型SCI 25例(39.06%),速发型SCI仍占较大比例;截瘫患者52例(81.25%),轻瘫患者12例(18.75%);出院未恢复永久性SCI 38例(59.38%),部分恢复或完全恢复25例(39.06%),死亡1例(1.56%)。与对照组比较,规范化综合性脊髓保护措施实施后,SCI发生率明显下降,主动脉手术后SCI总体发生率由1.06%(52/4 893)下降至0.42%(12/2 831),其中深低温停循环下全主动脉弓置换术后SCI发生率由3.66%(40/1 092)下降至1.11%(5/450),全胸腹主动脉置换术后SCI发生率由9.40%(11/117)下降至2.47%(2/81),差异均有统计学意义(均P<0.05)。围手术期CSFD情况分析显示,CSFD相关并发症发生率较低,总体发生率为5.45%(3/55),其中脑脊液漏1例,血性脑脊液2例,无中枢神经系统出血、感染等严重并发症发生。结论主动脉手术后SCI以速发型为主,约39%的SCI患者可以部分或者完全恢复;包括预防Objective To observe the incidence of spinal cord injury(SCI)following aortic surgery in Fuwai Hospital of Chinese Academy of Medical Sciences,and evaluate the effect of standardized multidisciplinary spinal cord protection strategies,to summarize the experience in the prevention and treatment of SCI at perioperative period of aortic surgery.Methods The clinical data of patients underwent aortic surgery admitted to vascular center of Fuwai Hospital from January 2011 to December 2018 were retrospectively analyzed.The patients receiving traditional spinal cord protection strategies from January 2011 to December 2016 were defined as the control group,while the patients receiving standardized multidisciplinary spinal cord protection strategies from January 2017 to December 2018 were defined as the standardized treatment group.The standardized multidisciplinary treatment included preoperative cerebrospinal fluid drainage(CSFD),respiratory tract management,and maintenance of effective circulation of the lowest venous pressure;at the same time,anticoagulation,glucocorticoid,improve microcirculation,scavenge oxygen free radicals and other adjuvant treatments were started,and nerve function was monitored to prevent complications.The changes in SCI incidence after aortic surgery between the two groups were observed in order to evaluate the effect of standardized multidisciplinary spinal cord protection strategies.Meanwhile,the types of SCI after operation and the safety of CSFD were analyzed.Results During the 8-year period,7 724 patients underwent aortic surgery at vascular center of Fuwai Hospital,64 of which suffered from SCI after aortic surgery with total incidence of 0.83%.The onset of SCI was immediate in 39 patients(60.94%)and was delayed in 25 patients(39.06%),more than half of patients were immediate SCI.Of 64 patients with SCI,52 patients(81.25%)underwent paraplegia and 12(18.75%)underwent paraparesis.SCI persisted beyond discharge in 38 patients(59.38%)and 25 patients(39.06%)fully or partly recovered form SCI.O

关 键 词：脊髓损伤 主动脉手术 脊髓保护措施 脑脊液引流 

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