Hashem M, Cinà C S
Senior Specialist Registrar, Singleton Hospital, Swansea, UK.
Acta Anaesthesiol Belg. 2007;58(1):45-54.
Thoracoabdominal aortic aneurysms are one of the most challenging surgeries for the anaesthetists. They account for 10% of aneurysms of the aorta. A thorough understanding of pathophysiology, anatomy, and surgical interventions including extracorporeal circulation are essential to achieve a good outcome. Crawford classified them accorting to their their extent and location in 4 types. Patients with Crawford type II aneurysms are at greatest risk for paraplegia and renal failure from ischemia to the spinal cord and kidneys during cross-clamp. Neurologic and renal complications are significant for the most extensive forms of aneurysms. Mortality has improved over time as a consequence of either increased surgical experience, the adoption of a protocolized strategy for repair, or secular improvements in anaesthetic and intensive care treatment. Long-term survival after elective TAAA repair is excellent.
胸腹主动脉瘤是麻醉医生面临的最具挑战性的手术之一。它们占主动脉瘤的10%。全面了解病理生理学、解剖学以及包括体外循环在内的手术干预措施对于取得良好预后至关重要。克劳福德根据其范围和位置将它们分为4种类型。克劳福德II型动脉瘤患者在交叉钳夹期间因脊髓和肾脏缺血而发生截瘫和肾衰竭的风险最大。神经和肾脏并发症对于最广泛形式的动脉瘤来说很严重。随着手术经验的增加、采用规范化的修复策略或麻醉和重症监护治疗的长期改善，死亡率随时间有所下降。择期胸腹主动脉瘤修复术后的长期生存率很高。
