Kouchoukos N T, Rokkas C K
The Heart Center, Missouri Baptist Medical Center, St. Louis, USA.
Ann Thorac Surg. 1999 Jun;67(6):1940-2; discussion 1953-8. doi: 10.1016/s0003-4975(99)00442-7.
Hypothermic cardiopulmonary bypass with or without circulatory arrest has been used successfully for the treatment of complex aneurysms of the descending thoracic and thoracoabdominal aorta. Hypothermia has a protective effect on spinal cord function, and its use has been associated with a low incidence of paraplegia in traditionally high-risk patients. Experimentally, the protective effect of hypothermia has been related to amelioration of excitotoxic injury by reduction of neurotransmitter release and to inhibition of delayed apoptotic cell death.
During a 12-year period, 114 patients with descending thoracic or thoracoabdominal aortic disease underwent replacement of the involved aortic segments using hypothermic cardiopulmonary bypass and intervals of circulatory arrest.
The hospital mortality was 8% (9 patients). Paraplegia occurred in 2 and paraparesis in 1 of the 108 patients whose lower limb function was assessed postoperatively (2.8%). None of 40 patients with aortic dissection and none of the last 81 patients in the series developed paralysis.
Our experience with hypothermic cardiopulmonary bypass and circulatory arrest confirms that hypothermia provides substantial protection against paraplegia, and it allows complex operations on the descending thoracic and thoracoabdominal aorta to be performed with acceptable mortality.
伴有或不伴有循环骤停的低温体外循环已成功用于治疗降主动脉和胸腹主动脉的复杂动脉瘤。低温对脊髓功能具有保护作用,在传统高危患者中使用低温与截瘫发生率较低相关。在实验中,低温的保护作用与通过减少神经递质释放改善兴奋性毒性损伤以及抑制延迟性凋亡细胞死亡有关。
在12年期间,114例降主动脉或胸腹主动脉疾病患者接受了低温体外循环及循环骤停间歇期的受累主动脉段置换术。
医院死亡率为8%(9例患者)。在术后评估下肢功能的108例患者中,2例发生截瘫,1例发生轻瘫(2.8%)。40例主动脉夹层患者中无一例发生瘫痪,该系列最后81例患者中也无一例发生瘫痪。
我们在低温体外循环和循环骤停方面的经验证实,低温可为预防截瘫提供实质性保护,并使降主动脉和胸腹主动脉的复杂手术能够在可接受的死亡率下进行。