Department of Anesthesia, University of Manitoba, Winnipeg, Manitoba R2H2A6, Canada.
Anesth Analg. 2010 Jul;111(1):46-58. doi: 10.1213/ANE.0b013e3181ddddd6. Epub 2010 Jun 3.
Paraplegia remains one of the most devastating complications of thoracoabdominal aortic surgery and is associated with a significant increase in both morbidity and mortality. Modern aortic repair techniques use many modalities aimed at reducing the risk of spinal cord ischemia inherent with surgical management. One of these modalities that acts via optimizing spinal cord blood flow is lumbar cerebrospinal fluid (CSF) drainage. Either alone or in combination with other interventions, CSF drainage remains one of the most frequently used spinal cord protection techniques. Despite no definitive proof of efficacy for reducing spinal cord injury, there are compelling data supporting its use. However, the potential benefit of CSF drainage must be balanced against the risks associated with its use, including nerve injury during insertion, compressive neuraxial hematoma formation, intracranial hemorrhage due to excessive drainage, and infection. The optimal benefit to risk ratio can be achieved by understanding the rationale for its use and following practical management guidelines.
截瘫仍然是胸主动脉和腹主动脉手术最严重的并发症之一，与发病率和死亡率的显著增加相关。现代主动脉修复技术采用了许多旨在降低手术治疗中脊髓缺血固有风险的方法。通过优化脊髓血流起作用的方法之一是腰脑脊液（CSF）引流。CSF 引流单独或与其他干预措施联合使用，仍然是最常用的脊髓保护技术之一。尽管没有明确的证据证明其可以降低脊髓损伤的疗效，但有令人信服的数据支持其使用。然而，CSF 引流的潜在益处必须与使用相关的风险相平衡，包括插入过程中的神经损伤、压迫性中枢神经系统血肿形成、过度引流导致的颅内出血和感染。通过了解其使用的基本原理并遵循实用的管理指南，可以实现最佳的获益与风险比。
