University of Pennsylvania, Philadelphia, PA 19104-4283, USA.
Curr Opin Anaesthesiol. 2010 Feb;23(1):95-102. doi: 10.1097/ACO.0b013e3283348975.
Spinal cord ischemia remains an important complication of open surgical and endovascular stent graft repair of thoracic and thoracoabdominal aortic aneurysm despite advances in operative technique. Identification of risk factors and interventions to prevent and treat spinal cord ischemia has the potential to prevent spinal cord infarction and the morbidity and mortality associated with paraplegia.
Risk factors for spinal cord ischemia are aneurysm extent, open surgical repair, prior distal aortic operations, and perioperative hypotension. Augmenting spinal cord perfusion by increasing arterial pressure, lumbar cerebrospinal fluid drainage, and reattachment of segmental arteries are effective for the treatment of spinal cord ischemia. Early detection of spinal cord ischemia by intraoperative neurophysiologic monitoring and postoperative neurological examination is important to enable immediate treatment to prevent permanent paraplegia.
Permanent paraplegia after thoracic and thoracoabdominal aortic aneurysm repair can be prevented in many high-risk patients by early detection and immediate treatment of spinal cord ischemia before it evolves to infarction. The mortality and morbidity associated with permanent paraplegia justifies the risks and uncertainties associated with established therapeutic interventions.
尽管手术技术不断进步，脊髓缺血仍然是开放式外科手术和血管内支架移植物修复胸主动脉和胸腹主动脉瘤的重要并发症。识别风险因素和干预措施以预防和治疗脊髓缺血有可能预防脊髓梗死以及与截瘫相关的发病率和死亡率。
脊髓缺血的危险因素包括动脉瘤程度、开放式外科修复、先前的远端主动脉手术和围手术期低血压。通过增加动脉压、腰脑脊液引流和节段动脉再附着来增加脊髓灌注对于治疗脊髓缺血是有效的。通过术中神经生理监测和术后神经学检查早期发现脊髓缺血对于及时治疗以防止永久性截瘫很重要。
通过在脊髓缺血进展为梗死之前早期发现和立即治疗，许多高危患者可以预防胸主动脉和胸腹主动脉瘤修复后的永久性截瘫。与永久性截瘫相关的死亡率和发病率证明了与既定治疗干预相关的风险和不确定性是合理的。
