主动脉腔内修复术后发生脊髓缺血损伤相关危险因素分析  

Risk factors of spinal cord ischemic injury after endovascular aortic repair

作　　者：李辉[1] 李娟[2] 王振东[1] 高晓玲[3] 王东[1] LI Hui;LI Juan;WANGZhen-dong;GAO Xiao-ling;WANG Dong(Department of Cardiovascular Surgery,Linfen People’s Hospital,Linfen 041000,China)

机构地区：[1]临汾市人民医院心脏大血管外科,山西临汾041000 [2]临汾市人民医院消化内科,山西临汾041000 [3]临汾市人民医院CT室,山西临汾041000

出　　处：《中国介入心脏病学杂志》2020年第5期252-256,共5页Chinese Journal of Interventional Cardiology

基　　金：国家“十三五”重大科技计划精准医学专项合作项目(编号2016YFC0903100);临汾市人民医院科研基金项目。

摘　　要：目的探讨主动脉腔内修复术(TEVAR)后发生脊髓缺血损伤的相关危险因素。方法回顾性分析临汾市人民医院心脏大血管外科在2014年1月至2019年3月行TEVAR治疗的胸主动脉疾病患者96例。根据术后是否发生脊髓缺血损伤分为两组:脊髓损伤组11例,脊髓未损伤组85例。收集患者一般资料(年龄、性别、合并症)、病变长度、发病时间、腹主动脉累及情况,术中支架长度、左锁骨下动脉干预情况、术后血压情况等,使用卡方检验或t检验分析危险因素,并进行logistic多因素分析。结果脊髓损伤组患者发病时间<14 d(63.6%比29.4%,P=0.006)、病变长度>200 mm(72.7%比38.8%,P=0.046)、累及腹主动脉(72.7%比41.2%,P=0.001)、支架长度>200 mm(81.8%比16.5%,P<0.001)、置入支架>1枚(63.6%比14.1%,P=0.003)、支架覆盖左锁骨下动脉(54.5%比27.1%,P=0.021)及术后收缩压低于90 mmHg(1 mmHg=0.133 kPa)(63.6%比15.3%,P=0.007)患者比例均显著高于脊髓未损伤组患者,差异均有统计学意义。logistic单因素回归分析显示,发病时间<14 d、病变长度>200 mm、累及腹主动脉、支架长度>200 mm、置入支架>1枚、支架覆盖左锁骨下动脉、术后收缩压低于90 mmHg均与脊髓缺血损伤发生相关。logistic多因素回归分析显示,支架长度>200 mm是影响患者术后脊髓缺血损伤的独立危险因素(OR 4.843,95%CI 1.229~35.438,P=0.028)。结论TEVAR术中支架长度>200 mm是术后发生脊髓缺血损伤的独立危险因素。Objective To investigate the risk factors of spinal cord ischemia injury after endovascular aortic repair. Methods A retrospective analysis was made on 96 patients with thoracic aortic disease who underwent interventional endovascular therapy in our hospital from January 2014 to March 2019. There were 11 patients with spinal cord ischemic injury occurred after operation, including 3 paraplegia and 8 incomplete paraplegia, together with 85 cases without spinal cord ischemic injury. General data of patients(age,sex,complications),length of lesions, onset time, abdominal aorta involvement, intraoperative stent placement length, left subclavian artery intervention, blood pressure after operation were collected. Risk factors were analyzed by single factor chi-square test or t test, and multivariate analysis was performed by logistic regression. Results Univariate logistic regression analysis showed that shorter onset time of spinal cord ischemia(<14 d), longer lesion length(>200 mm), abdominal aorta involved, longer stent(>200 mm), more than one stent, stent covering left subclavian artery, and lower systolic blood pressure(<90 mmHg) were associated with a higher risk of spinal cord ischemia injury.Multivariate logistic regression analysis showed that stent length greater than 200 mm is an independent risk factor of spinal cord ischemic injury after operation(OR 4.843, 95%CI 1.229–35.438,P=0.028). Conclusions The length of stent implantation greater than 200 mm is an independent risk factor of spinal cord ischemic injury after operation.

关 键 词：主动脉腔内修复术 胸主动脉疾病 脊髓缺血损伤 并发症 

分 类 号：R543.1[医药卫生—心血管疾病] R654.3[医药卫生—内科学]