Spinal cord protection during thoracoabdominal aneurysm resection.
Spinal cord protection during thoracoabdominal aneurysm resection.
复制标题
胸腹动脉瘤切除术中的脊髓保护。
DOI：
10.1016/s0022-5223(95)70209-1
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发表时间：
1995
期刊：
影响因子：
--
通讯作者：
P. A. Wojewski
中科院分区：
文献类型：
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作者：
P. A. Wojewski
截瘫是胸腹部动脉瘤切除术后的一种严重并发症。目前已探索出多种脊柱保护方法。目前，还没有可靠的方法来保护脊柱免受缺血性损伤。我在这里描述两例胸腹动脉瘤切除术与选择性冷却脊髓。在主动脉交叉夹闭的同时，通过腰椎穿刺将冷生理盐水溶液连续灌洗脊髓引入蛛网膜下腔。例1主动脉阻断58分钟后无神经系统后遗症，例2阻断36分钟后无神经系统后遗症。一位72岁的女性被介绍给我有症状的胸腹动脉瘤。血管造影显示一个大动脉瘤起源于主动脉弓远端，蔓延到整个胸主动脉，并累及肾动脉下方的大部分腹主动脉。脊髓保护方案由拉皮德城地区医院的机构审查委员会批准。手术当天，患者首先被带到血管造影室，将导管置入蛛网膜下腔。该手术由侵入性放射科医生在患者重度镇静下进行。将患者俯卧在具有倾斜功能的X线透视检查床上。用20号脊椎穿刺针在L2-3水平用中线穿刺棒进入蛛网膜下腔（图1）。Cook微穿刺系统导丝（Cook Incorporated，布卢明顿，印第安纳州）然后通过脊椎穿刺针置入蛛网膜下腔，并在中线向上推进。在将扩张导管定位在蛛网膜下腔内的腹侧之后，将具有0.018尖端的0.035 Tad II导丝（Advanced Cardiovascular Systems，Inc.，加利福尼亚州圣克拉拉）通过了Tad导丝是可操纵的，0.018的尖端有助于避免在推进导丝时损坏神经根或脊髓。Tad导丝位于脊髓腹侧T5上方。沿导丝放置5 F直型冲洗导管，并定位在T5上方。通过上述手术，将第二根5 F导管放置在脊髓圆锥水平。导管应在其头端设置四到五个额外的侧孔。如果可能的话，第二根导管进入蛛网膜下腔的入口应该比第一根导管的入口低一个水平。第三根导管放置在下一个水平，头端
Paraplegia is a devastating complication after thoracoabdominal aneurysm resection. Multi~) le methods of spinal protection have been explored. At present, no reliable method of protecting the spine from ischemic injury exists. I am describing here two cases of thoraco abdominal aneurysm resection with selective cooling of the spinal cord. While the aorta was crossclamped, continuous lavage of the spinal cord with cold normal saline solution was introduced into the subarachnoid space by lumbar puncture. No neurologic sequela developed after crossclamping of the aorta for 58 minutes in case 1 and 36 minutes in case 2.Case 1. A 72-year-old woman was referred to me with a symptomatic thoracoabdominal aneurysm. Angiography showed a large arteriosclerotic aneurysm originating in the distal aortic arch, propagating throughout the thoracic aorta, and involving most of the abdominal aorta below the renal arteries. Spinal cord protection protocol was approved by the Institutional Review Committee of the Rapid City Regional Hospital. On the day of the operation, the patient was taken first to the angio suite for placement of catheters to the subarachnoid space. The procedure was performed with the patient under heavy sedation by an invasive radiologist. The patient was placed prone on a fluoroscopic table with tilt capabilities. The subarachnoid space was entered at the L2-3 level with midline stick with a 20-gauge spinal needle (Fig. 1). The Cook micropuncture system guidewire (Cook Incorporated, Bloomington, Ind.) was then placed through the spinal needle into the subarachnoid space and advanced upward in the midline. After the dilating catheter was positioned ventral within the subarachnoid space, the 0.035 Tad II wire with 0.018 tip (Advanced Cardiovascular Systems, Inc., Santa Clara, Calif.) was passed. The Tad wire is steerable and the 0.018 tip helped avoid damage to nerve roots or cord while the wire was being advanced. The Tad wire was positioned above T5 ventral to the spinal cord. A 5F straight flush catheter was placed over the wire and positioned above T5. By means of the procedure just described, the second 5F catheter was placed at the level of the conus medullaris. The catheter should have four to five additional side holes placed at its tip. The entrance into the subarachnoid space for this second catheter should be, if possible, one level below the entrance of the first catheter. The third catheter was placed at the next inferior level with the tip