Delayed spinal cord deficits after thoracoabdominal aortic aneurysm repair
Delayed spinal cord deficits after thoracoabdominal aortic aneurysm repair
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DOI：
10.1016/j.athoracsur.2006.11.035
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发表时间：
2007-04-01
影响因子：
4.6
通讯作者：
LeMaire, Scott A.
中科院分区：
文献类型：
--
作者：
Wong, Daniel R.;Coselli, Joseph S.;LeMaire, Scott A.
背景。关于胸腹主动脉瘤（TAAA）修复术后迟发性截瘫的治疗和结果的信息有限。本研究的目的是评估促成和有利影响迟发性神经功能缺损的因素。方法。 19 年期间，共进行了 2,368 次 TAAA 维修。在 93 名术后截瘫或下肢轻瘫患者 (3.9%) 中，34 名 (37%) 最初神经功能完好，但出现迟发性脊髓缺损。我们回顾性地研究了与缺陷发展相关的临床因素和事件、所使用的治疗方法和结果。通过比较出院或转院时能走动的幸存者与不能走动的幸存者来评估与功能状态相关的因素。结果。延迟性功能障碍发生在术后 13 小时至 91 天之间，并且与 9 名患者 (26%) 的低血压期相关。两名患者（6%）在医院死亡。在 32 名出院或转院患者中，13 名（41%）可以卧床休息。功能结果不佳与女性、术中脑脊液引流、肋间动脉重新连接较少以及使用皮质类固醇或渗透性利尿剂有关。门诊患者的 2 年精算生存率为 80% +/- 13%，非门诊患者为 32% +/- 12% (p = 0.002)。结论。尽管诱发灌注不足的事件很常见，但大多数迟发性截瘫病例的发生并没有发生此类事件，这表明其他因素可能在这种并发症的发生中发挥着重要作用。出院时的卧床状态可显着预测中期生存率。
Background. Limited information is available about the treatment and outcomes of delayed paraplegia after thoracoabdominal aortic aneurysm (TAAA) repair. The objective of this study was to assess factors that precipitate and favorably affect delayed-onset neurologic deficits.Methods. Over a 19-year period, 2,368 TAAA repairs were performed. Of the 93 patients (3.9%) who had postoperative paraplegia or paraparesis, 34 (37%) initially had intact neurologic function, but a delayed spinal cord deficit developed. We retrospectively examined clinical factors and events associated with development of the deficits, treatments used, and outcomes. Factors related to functional status were evaluated by comparing survivors who were ambulatory at discharge or transfer with those who were not.Results. The delayed deficits occurred between 13 hours and 91 days postoperatively and were associated with a period of hypotension in 9 patients (26%). Two patients (6%) died in hospital. Of the 32 patients discharged or transferred, 13 (41%) were ambulatory. Poor functional outcomes were associated with female sex, intraoperative cerebrospinal fluid drainage, fewer intercostal arteries reattached, and administration of corticosteroids or osmotic diuretics. The actuarial survival rate at 2 years was 80% +/- 13% for the ambulatory patients and 32% +/- 12% for the nonambulatory patients (p = 0.002).Conclusions. Although precipitating episodes of hypoperfusion were common, most cases of delayed paraplegia occurred without such events, suggesting that other factors may play an important role in the development of this complication. Ambulatory status at discharge significantly predicts midterm survival.