Paraplegia after extensive thoracic and thoracoabdominal aortic aneurysm repair: Does critical spinal cord ischemia occur postoperatively?
Paraplegia after extensive thoracic and thoracoabdominal aortic aneurysm repair: Does critical spinal cord ischemia occur postoperatively?
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DOI：
10.1016/j.jtcvs.2007.11.002
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发表时间：
2008-02-01
影响因子：
6
通讯作者：
Griepp, Randall B.
中科院分区：
文献类型：
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作者：
Etz, Christian D.;Luehr, Maximilian;Griepp, Randall B.
目的：脊髓损伤不仅可以发生在广泛的胸腹部动脉瘤修复术，但也术后，造成迟发性parapleg.Methods：一系列的858胸腹部动脉瘤修复术（1990年6月至2006年6月）的总体截瘫率为2.7%进行了回顾性分析。通过体感诱发电位监测连续节段性动脉牺牲;节段性动脉不重新植入。在总共20例截瘫病例中，3例发生在术中，7例发生在术后晚期：这些病例将不作进一步分析。在10例（截瘫组）脊髓损伤发生在胸腹部动脉瘤修补术后48小时内，尽管完整的体感诱发电位在手术结束时。这些患者术后早期迟发性截瘫与10个匹配的对照组谁恢复无脊髓injure.Results：在截瘫组的中位数9节段动脉（范围，5-12节段动脉）被牺牲。有9例男性受试者：中位年龄为63岁（范围：40-79岁），10例受试者中有4例接受了脑脊液引流。在匹配的恢复组中，还处死了平均9个节段动脉（范围，2-12个节段动脉）。有4例男性受试者;中位年龄为66岁（范围：40-78岁），10例受试者中有8例接受了脑脊液引流。在术后的前48小时内，动脉和混合静脉血氧饱和度、部分动脉O-2和CO2压、体温、葡萄糖、红细胞压积或pH值无显著差异。然而，截瘫患者术后1至5小时的平均中心静脉压显著较高（P = .03）。此外，虽然术后配对的绝对平均主动脉压没有差异，但当压力被视为个体先前术前平均主动脉压的百分比时，截瘫患者在术后前5小时内的值明显较低结论：这项研究表明，截瘫可能是由于术后脊髓灌注不足造成的，而脊髓灌注与对照组相比差异较小参数延迟性截瘫也许可以通过更好的血流动力学和液体管理来预防。
Objective: Spinal cord injury can occur not only during extensive thoracoabdominal aneurysm repair but also postoperatively, causing delayed-onset paraplegia.Methods: A series of 858 thoracoabdominal aneurysm repairs (June 1990-June 2006) with an overall paraplegia rate of 2.7% was analyzed retrospectively. Serial segmental artery sacrifice was monitored by using somatosensory evoked potentials; segmental arteries were not reimplanted. Of a total of 20 cases of paraplegia, 3 occurred intraoperatively and 7 occurred late postoperatively: these will not be analyzed further. In 10 cases (the paraplegia group) spinal cord injury occurred within 48 hours after thoracoabdominal aneurysm repair, despite intact somatosensory evoked potentials at the end of the procedure. These patients with early postoperative delayed paraplegia were compared with 10 matched control subjects who recovered without spinal cord injury.Results: In the paraplegia group a median of 9 segmental arteries (range, 5-12 segmental arteries) were sacrificed. There were 9 male subjects: median age was 63 years (range, 40-79 years), and 4 of 10 had cerebrospinal fluid drainage. A median of 9 segmental arteries (range, 2-12 segmental arteries) were also sacrificed in the matched recovery group. There were 4 male subjects; median age was 66 years (range, 40-78 years), and 8 of 10 had cerebrospinal fluid drainage. During the first 48 hours postoperatively, there were no significant differences in arterial and mixed venous oxygen saturation, partial arterial O-2 and CO2 pressures, body temperature, glucose, hematocrit, or pH. The mean central venous pressures, however, were significantly higher in the paraplegic patients from 1 to 5 hours postoperatively (P = .03). In addition, although absolute mean aortic pressures did not differ between matched pairs postoperatively, when pressures were considered as a percentage of individual antecedent preoperative mean aortic pressure, paraplegic patients had significantly lower values during the first 5 hours postoperatively (P = .03).Conclusions: This study suggests that paraplegia can result from inadequate postoperative spinal cord perfusion caused by relatively minor differences from control subjects in perfusion parameters. Delayed paraplegia can perhaps be prevented with better hemodynamic and fluid management.