在区域性脊髓低温下进行胸主动脉和胸腹主动脉修复术。
Thoracic and thoracoabdominal aortic repair under regional spinal cord hypothermia.
作者信息
Shimizu Hideyuki, Mori Atsuo, Yoshitake Akihiro, Yamada Tatsuya, Morisaki Hiroshi, Okano Hideyuki, Yozu Ryohei
机构信息
Department of Cardiovascular Surgery, Keio University, Tokyo, Japan
Department of Cardiovascular Surgery, Kawasaki Municipal Hospital, Kanagawa, Japan.
出版信息
Eur J Cardiothorac Surg. 2014 Jul;46(1):40-3. doi: 10.1093/ejcts/ezt574. Epub 2013 Dec 12.
OBJECTIVES
Spinal cord deficits are devastating complications after surgery for thoracic and thoracoabdominal aortic aneurysms. We developed a regional spinal cord cooling system using an epidural catheter containing cold saline within an isolated counter-current lumen to prevent such complications and reviewed the clinical results.
METHODS
We enrolled 37 patients with thoracic (n = 13) and thoracoabdominal (n = 24) aortic aneurysms that were repaired using the regional spinal cord cooling system under mild hypothermia with a partial femoro-femoral bypass.
RESULTS
Although 2 patients died before hospital discharge (hospital mortality, 5.4%), none developed neurological deficits such as paraplegia or paraparesis.
CONCLUSIONS
The outcomes of surgery for thoracic and thoracoabdominal aortic aneurysms under regional spinal cord hypothermia using a custom-designed epidural catheter were excellent. Although our patient cohort was small, the results indicate that our technique might help to improve the outcomes of thoracic and thoracoabdominal aortic repair.
目的
脊髓功能缺损是胸主动脉和胸腹主动脉瘤手术后的严重并发症。我们开发了一种区域脊髓冷却系统，该系统使用一根硬膜外导管，在隔离的逆流腔内置有冷盐水，以预防此类并发症，并回顾了临床结果。
方法
我们纳入了37例胸主动脉瘤（n = 13）和胸腹主动脉瘤（n = 24）患者，这些患者在轻度低温和部分股-股旁路循环下使用区域脊髓冷却系统进行修复。
结果
尽管2例患者在出院前死亡（医院死亡率为5.4%），但无一例出现截瘫或轻瘫等神经功能缺损。
结论
使用定制设计的硬膜外导管进行区域脊髓低温下的胸主动脉和胸腹主动脉瘤手术效果极佳。尽管我们的患者队列规模较小，但结果表明我们的技术可能有助于改善胸主动脉和胸腹主动脉修复的效果。
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