Naloxone and spinal fluid drainage as adjuncts in the surgical treatment of thoracoabdominal and thoracic aneurysms.
Naloxone and spinal fluid drainage as adjuncts in the surgical treatment of thoracoabdominal and thoracic aneurysms.
复制标题
纳洛酮和脊髓液引流作为胸腹和胸动脉瘤手术治疗的辅助手段。
作者：
C. Acher;M. Wynn;J. Archibald
对47例在5年半时间内接受胸腹部或胸部动脉瘤治疗的患者进行神经功能缺损风险分析。将患者分为两组进行分析。1984年1月至1986年12月治疗的24例患者未接受脊髓液引流或纳洛酮给药（A组）。1987年1月至1989年8月治疗的23名患者进行了脊髓液引流（B组）;该组中的12名患者还在术后48小时内以1 μ g/kg/hr的速度静脉滴注纳洛酮。A组7例（29%）患者发生永久性神经功能缺损，但B组仅1例（4%）患者未接受纳洛酮治疗（p <0.03）。前两个B组患者接受纳洛酮显示完全逆转的神经功能缺损从麻醉中醒来。神经功能缺损的显著减少与1年生存率的增加相关（A组72%，B组91%）。我们得出结论，纳洛酮和脊髓液引流的使用减少了与胸腹和胸主动脉瘤修复相关的神经功能缺损的发生率。这种神经功能缺损的减少与长期生存率的提高有关。观察到的纳洛酮对术后神经功能缺损的逆转表明阿片类药物是脊髓缺血病理生理学的主要因素。
Forty-seven patients who were treated for thoracoabdominal or thoracic aneurysms over a 5 1/2-year period were analyzed for neurologic deficit risk. Patients were divided into two groups for analysis. Twenty-four patients, who were treated from January 1984 to December 1986, did not undergo spinal fluid drainage or naloxone administration (group A). Twenty-three patients, who were treated from January 1987 to August 1989, had spinal fluid drainage (group B); 12 patients in this group also received naloxone as an intravenous drip at 1 microgram/kg/hr for 48 hours after surgery. Permanent neurologic deficits occurred in seven (29%) group A patients but in only one (4%) group B patient, who did not receive naloxone (p less than 0.03). The first two group B patients to receive naloxone showed complete reversal of neurologic deficits on waking from anesthesia. This significant reduction in neurologic deficit was associated with an increased 1-year survival rate (72% in group A, 91% in group B). We conclude that the use of naloxone and spinal fluid drainage reduces the incidence of neurologic deficit that is associated with repair of thoracoabdominal and thoracic aortic aneurysms. This reduction in neurologic deficit is associated with improved survival in the long term. The observed reversal of postoperative neurologic deficits with naloxone implicates opiates as a major factor in the pathophysiology of spinal cord ischemia.