胸主动脉腔内修复术后截瘫危险因素分析  

Analysis of the risk factors for paraplegia after thoracic endovascular aortic repair

作　　者：冀振春[1] 沈振亚[1] 余云生[1] 叶文学[1] 黄浩岳[1] 华菲[1] 陈一欢[1] 胡雁秋[1] 苏成锴 JI Zhenchun;SHEN Zhenya;YU Yunsheng;YE Wenxue;HUANG Haoyue;HUA Fei;CHEN Yihuan;HU Yanqiu;SU Chengkai(Department of Cardiovascular Surgery,First Affiliated Hospital of Soochow University,Suzhou,Jiangsu Province 215006,China)

机构地区：[1]苏州大学附属第一医院心脏大血管外科,江苏苏州215006

出　　处：《介入放射学杂志》2022年第12期1160-1164,共5页Journal of Interventional Radiology

摘　　要：目的探讨胸主动脉腔内修复术(TEVAR)后发生截瘫的危险因素。方法回顾性分析2015年12月至2021年2月在苏州大学附属第一医院接受TEVAR治疗的307例Stanford B型主动脉夹层或胸主动脉瘤患者临床和影像资料。根据术后有无截瘫发生将患者分为截瘫组(8例)和无截瘫组(299例)。观察患者临床指标及围手术期主动脉CTA检查结果。对两组间差异有统计学意义的临床指标进行单因素和多因素logistic回归分析。结果术后截瘫总发生率为2.61%。两组患者间伴冠心病、假腔血栓、围手术期低血压、支架远端距腹腔干开口长度、支架远端真腔狭窄率参数差异有统计学意义(均P<0.05)。单因素logistic回归分析显示,围手术期低血压、支架远端距腹腔干开口长度、真腔狭窄率是截瘫发生的危险因素(均P<0.05)。多因素logistic回归分析显示,围手术期低血压、支架远端距腹腔干开口长度、真腔狭窄率是截瘫发生的独立危险因素(均P<0.05)。结论围手术期低血压、支架远端距腹腔干开口长度、真腔狭窄率是TEVAR术后并发截瘫的预测因子。对于主动脉破口较低患者仍需寻找更优化方案封堵破口,保护脊髓供血,避免截瘫发生。Objective To investigate the risk factors for the occurrence of paraplegia after thoracic endovascular aortic repair(TEVAR).Methods The clinical data and imaging materials of a total of 307 patients with Stanford type B aortic dissection or thoracic aortic aneurysm,who received TEVAR at the First Affiliated Hospital of Soochow University of China between December 2015 and February 2021,were retrospectively analyzed.Patients were divided into paraplegia group(n=8)and non-paraplegic group(n=299)according to the presence of postoperative paraplegia.The clinical indexes and perioperative aortic CTA examination results were recorded.Univariate analysis and multivariate logistic regression analysis were used to analyze the clinical indicators that had statistically significant difference between the two groups.Results The total incidence of postoperative paraplegia was 2.61%.Statistically significant differences in coronary heart disease,false lumen thrombosis,perioperative hypotension,the length from the stent distal end to the celiac trunk opening,and the stenosis ratio of true lumen distal to the stent existed between the two groups(all P<0.05).Univariate logistic regression analysis showed that perioperative hypotension,the length from the stent distal end to the celiac trunk opening,and the stenosis ratio of true lumen distal to the stent were the risk factors for the occurrence of paraplegia(all P<0.05).Multivariate logistic regression analysis indicated that the perioperative hypotension,the length from the stent distal end to the celiac trunk opening,and the stenosis ratio of true lumen distal to the stent were the independent risk factors for the occurrence of paraplegia after TEVAR(all P<0.05).Conclusion The perioperative hypotension,the length from the stent distal end to the celiac trunk opening,and the stenosis ratio of true lumen distal to the stent are the predictors of postoperative paraplegia after TEVAR.For patients who has low-position aortic rupture,in order to protect the blood supply to the spinal

关 键 词：胸主动脉腔内修复术 截瘫 危险因素 

分 类 号：R654.3[医药卫生—外科学]