Neurologic outcome after thoracic and thoracoabdominal aortic aneurysm repair
Neurologic outcome after thoracic and thoracoabdominal aortic aneurysm repair
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DOI：
10.1016/s0003-4975(01)02971-x
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发表时间：
2001-10-01
影响因子：
4.6
通讯作者：
Safi, HJ
中科院分区：
文献类型：
--
作者：
Estrera, AL;Miller, CC;Safi, HJ
背景。胸、胸腹主动脉修复后的神经功能缺损（截瘫和截瘫）仍然是一个毁灭性的并发症。本研究的目的是确定脑脊液引流和远端主动脉灌注对胸胸腹主动脉瘤（TAAA）修复过程中神经功能的影响。在1991年2月至2000年3月间，我们进行了654例胸腹主动脉修复手术。中位年龄为67岁，420例（64%）患者为男性。急诊45例（6.9%）。TAAA分布如下：I区，164区（25%）；范围II， 165 (25%)；范围III， 61 (9%)；IV区，95% (15%)；范围V， 23 (3.5%)；胸降段147例（22%）。428例（65%）采用辅助脑脊液引流和主动脉远端灌注。30天死亡率为14%（654例中94例）。住院死亡率为16%（654例中106例）。早期神经功能缺损33例（5.0%）。总体而言，428例神经功能缺损患者中有14例（3.3%）为辅助治疗组，226例患者中有19例（8.4%）为非辅助治疗组（P = 0.004）。当在II段修复中使用辅助材料时，发病率为10 / 129(7.8%)，而非辅助材料组为11 / 36 (30.6%)（p < 0.001）。多因素分析显示脑血管疾病和TAAA程度（II和III）是神经功能障碍的危险因素（p < 0.05）。远端主动脉灌注和脑脊液引流的联合辅助治疗表明，胸椎和TAAAs的修复改善了神经系统预后。在II级动脉瘤中，辅助动脉瘤继续对预后产生相当大的影响，并对脊髓发病提供重要的保护。未来的研究应侧重于高危II级动脉瘤患者的脊髓保护。(C) 2001年由胸外科医生协会。
Background. Neurologic deficit (paraparesis and paraplegia) after repair of the thoracic and thoracoabdominal aorta remains a devastating complication. The purpose of this study was to determine the effect of cerebrospinal fluid drainage and distal aortic perfusion upon neurologic outcome during repair of thoracic and thoracoabdominal aortic aneurysm (TAAA) repair.Methods. Between February 1991 and March 2000, we performed 654 repairs of the thoracic and thoracoabdominal aorta. The median age was 67 years and 420 (64%) patients were male. Forty-five cases (6.9%) were performed emergently. Distribution of TAAA was the following: extent I, 164 (25%); extent II, 165 (25%); extent III, 61 (9%); extent IV, 95 (15%); extent V, 23 (3.5%); and descending thoracic, 147 (22%). The adjuncts cerebrospinal fluid drainage and distal aortic perfusion were used in 428 cases (65%).Results. Thirty-day mortality was 14% (94 of 654). The in-hospital mortality was 16% (106 of 654). Early neurologic deficits occurred in 33 patients (5.0%). Overall, 14 of 428 (3.3%) neurologic deficits were observed in the adjunct group, and 19 of 226 (8.4%) in the nonadjunct group (P = 0.004). When the adjuncts were used during extent II repair, the incidence was 10 of 129 (7.8%) compared with 11 of 36 (30.6%) in the nonadjunct group (p < 0.001). Multivariate analysis demonstrated that risk factors for neurologic deficit were cerebrovascular disease and extent of TAAA (II and III) (p < 0.05).Conclusions. The combined adjuncts of distal aortic perfusion and cerebrospinal fluid drainage demonstrated improved neurologic outcome with repair of thoracic and TAAAs. In extent II aneurysms, adjuncts continue to make a considerable difference in the outcome and to provide significant protection against spinal cord morbidity. Future research should focus on spinal cord protection in patients with high-risk extent II aneurysms. (C) 2001 by The Society of Thoracic Surgeons.