外科开放手术直视下Stanford B型胸主动脉夹层腔内修复术后截瘫的临床研究  

Clinical Study of Paraplegia after Endovascular Repair of Stanford B Thoracic Aortic Dissection under Open Surgery

作　　者：吴先志 马中原 李明 蔡巧玲 WU Xianzhi;MA Zhongyuan;LI Ming;CAI Qiaoling(Department of Cardiothoracic Surgery,Zhuhai People's Hospital,Zhuhai,Guangdong Province,519000 China)

机构地区：[1]珠海市人民医院心胸外科,广东珠海519000

出　　处：《中外医疗》2021年第17期21-24,共4页China & Foreign Medical Treatment

基　　金：珠海市科技计划项目(20181117E030053)。

摘　　要：目的探讨外科开放手术直视下Stanford B型胸主动脉夹层腔内修复术后截瘫的临床影响因素及相应的防治方法。方法便利选取该院2013年5月—2019年6月诊治的StanfordB型胸主动脉夹层患者134例。根据胸主动脉夹层(StanfordB型)患者的临床资料,统计并分析在外科开放手术直视下患者腔内修复术后截瘫例数及相应的影响因素。结果共有5例截瘫患者,129例无截瘫患者。在术后截瘫影响因素单变量关系分析中,无截瘫及有截瘫患者各因素分别为高脂血症14例,1例;糖尿病2例,1例;吸烟104例,5例;脑血管疾病7例,0例;肺部疾病4例,0例及肾功能衰竭4例,0例,差异无统计学意义(P=0.453、0.108、0.583、0.762、0.857、0.857);高血压70例,0例,差异有统计学意义(P=0.023)。在术后截瘫与手术因素单变量关系分析中,无截瘫及有截瘫患者各因素分别为限制性裸支架18例,1例;“烟囱”技术16例,0例;Ⅰ内漏4例,0例;Ⅱ内漏4例,0例及腹主动脉瘤外科干预事故4例,0例;左锁骨下动脉封堵15例,1例差异无统计学意义(P=0.540、0.524、0.857、0.857、0.857、0.476);平均动脉压小于70 mmHg 3例,4例,差异有统计学意义(P<0.05)。术后截瘫5例患者中封堵LSA有1例,裸支架置入1例,围术期低血压3例。截瘫患者经联合治疗后神经系统评分均恢复至5级。结论外科开放手术直视下StanfordB型胸主动脉夹层腔内修复术后有无截瘫患者在高血压、平均动脉压小于70 mmHg方面存在差异。Objective To investigate the clinical influencing factors and corresponding prevention and treatment methods of paraplegia after Stanford B-type thoracic aortic dissection endovascular repair under open surgery.Methods A total of 134 patients with Stanford type B thoracic aortic dissection who were diagnosed and treated in the hospital from May 2013 to June 2019 were convenient selected.According to the clinical data of patients with thoracic aortic dissection(Stanford type B),statistics and analysis of the number of cases of paraplegia after endovascular repair under open surgery and the corresponding influencing factors.Results There were 5 patients with paraplegia and 129 patients without paraplegia.In the univariate analysis of the influencing factors of postoperative paraplegia,the factors of patients without paraplegia and paraplegia were 14 cases and 1 case of hyperlipidemia;2 cases and 1 case of diabetes;104 cases and 5 cases of smoking;7 cases and 0 cases of cerebrovascular disease;4 cases and 0 cases of lung diseas;4 cases and 0 cases of renal failure,the difference was not statistically significant(P=0.453,0.108,0.583,0.762,0.857,0.857);70 cases and 0 Cases of hypertension,the difference was statistically significant(P=0.023).In the univariate analysis of postoperative paraplegia and surgical factors,the factors of patients without paraplegia and patients with paraplegia were 18 cases and 1 case of restrictive bare stents;16 cases and 0 cases of"chimney"technique;4 cases and 0 cases of endoleakⅠ;4 cases and 0 cases ofⅡendoleak;4 cases and 0 case of abdominal aortic aneurysm surgical intervention accidents;15 cases and 1 case of left subclavian artery occlusion,the difference was not statistically significant(P=0.540,0.524,0.857,0.857,0.857,0.476);the mean arterial pressure was less than 70 mmHg in 3 cases and 4 cases,the difference was statistically significant(P<0.001).Among the 5 patients with postoperative paraplegia,1 case had LSA occluded,1 case had bare stent implantation,and 3 cases had peri

关 键 词：外科开放手术直视 Stanford B型胸主动脉夹层 腔内修复 术后截瘫 临床研究 

分 类 号：R654[医药卫生—外科学]