Evolving concepts in prevention of spinal cord injury during operations on the descending thoracic and thoracoabdominal aorta.
Evolving concepts in prevention of spinal cord injury during operations on the descending thoracic and thoracoabdominal aorta.
复制标题
胸降主动脉和胸腹主动脉手术期间预防脊髓损伤的概念不断演变。
DOI：
10.1016/s0003-4975(10)62163-7
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发表时间：
1987
期刊：
影响因子：
--
通讯作者：
N. Kouchoukos
中科院分区：
文献类型：
--
作者：
J. Laschinger;H. Izumoto;N. Kouchoukos
胸降主动脉或胸腹主动脉手术后的脊髓损伤仍然是一个主要问题。在某些亚型的患者中，术后脊髓损伤的风险很大。虽然临床上已经使用了几种辅助手段来消除或减少这种并发症的发生率，但没有一种被证明是完全有效的。一个重要的原因是这些技术未能可靠和非侵入性地定位对脊髓循环至关重要的来自主动脉的动脉的起始点。由于术后脊髓损伤最可能是由于脊髓下段的缺血或缺氧所致，在主动脉阻断期间，应考虑使用辅助技术来通过充分灌流远端主动脉来保护脊髓功能，无论是否使用全身低温。为了实现这一点，当关键的肋间或腰部动脉从被排除的节段远端的主动脉开始时，可以使用部分体外循环进行远端灌流，当这些动脉从被排除的节段开始时，可以使用全身低温和植入肋间和腰动脉的全体外循环。此外，只要有可能，应在术中监测脊髓功能。
Spinal cord injury following operations on the descending thoracic or thoracoabdominal aorta remains a major problem. In certain subsets of patients, the risk of postoperative spinal cord injury is substantial. Although several adjuncts have been employed clinically to eliminate or reduce the frequency of this complication, none have proven to be completely effective. An important reason for this is the failure of these techniques to reliably and noninvasively localize the level of origin of arteries from the aorta that are critical to spinal cord circulation.Since postoperative spinal cord injury most likely results from ischemia or hypoxia of the lower segment of spinal cord, use of adjunctive techniques to preserve spinal cord function during aortic clamping by perfusing the distal aorta adequately with or without systemic hypothermia should be considered. To practically implement this, partial cardiopulmonary bypass for distal perfusion when the critical intercostal or lumbar arteries originate from the aorta distal to the excluded segment, and total cardiopulmonary bypass with systemic hypothermia and implantation of intercostal and lumbar arteries when these arteries originate from the excluded segment, can be used. In addition, whenever possible, intraoperative monitoring of spinal cord function should be performed.