Wongkornrat Wanchai, Yamamoto Shin, Sekine Yuji, Ono Makoto, Fujikawa Takuya, Oshima Susumu, Sasaguri Shiro
Siriraj Hospital, Mahidol University, Bangkok, Thailand
Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan.
Asian Cardiovasc Thorac Ann. 2015 May;23(4):406-11. doi: 10.1177/0218492314549563. Epub 2014 Sep 7.
Although the results of surgical repair of thoracoabdominal aortic aneurysm continue to improve, the incidence of paraplegia remains within a wide range depending on each institution. The purpose of this study was to find predictors of paraplegia following thoracoabdominal aortic aneurysm repair in our institute, using the current spinal cord protection strategies.
From January 2007 to December 2011, 200 consecutive patients underwent thoracoabdominal aortic aneurysm repair. Of these, 24 (12%) had Crawford extent I repair, 82 (41%) had extent II, 51 (25.5%) had extent III, 10 (5%) had extent IV, and 33 (16.5%) had extent V (modified by Safi). Aortic dissection was present in 101 (50.5%) patients. Adjuncts used during the procedures included left heart bypass in all patients, cerebrospinal fluid drainage in 164 (82%), and intercostal artery reimplantation in 76 (38%).
There were 20 (10%) hospital deaths including 6 (3%) within 30 days; hospital mortality was 8.8% in elective operations. Postoperative complications included paraplegia in 17 (8.5%) patients, stroke in 5 (2.5%), and acute renal failure requiring dialysis in 5 (2.5%). Logistic regression analysis revealed that significant factors for the development of paraplegia were preoperative hypotension (p = 0.005, odds ratio 18.5), intraoperative hypotension (p = 0.001, odds ratio 77.6), and an open distal anastomosis technique (p = 0.012, odds ratio 4.6).
The predictors of postoperative paraplegia in our institution were perioperative hypotension and an open distal anastomosis technique. Avoidance of these risk factors might diminish the incidence of postoperative paraplegia.
尽管胸腹主动脉瘤手术修复的结果持续改善，但根据各机构情况，截瘫发生率仍在较大范围内波动。本研究的目的是利用当前的脊髓保护策略，找出我院胸腹主动脉瘤修复术后截瘫的预测因素。
2007年1月至2011年12月，连续200例患者接受了胸腹主动脉瘤修复术。其中，24例（12%）为克劳福德I型修复，82例（41%）为II型，51例（25.5%）为III型，10例（5%）为IV型，33例（16.5%）为V型（由萨菲改良）。101例（50.5%）患者存在主动脉夹层。手术过程中使用的辅助措施包括所有患者均采用左心转流，164例（82%）患者采用脑脊液引流，76例（38%）患者采用肋间动脉再植。
有20例（10%）患者院内死亡，其中30天内死亡6例（3%）；择期手术的院内死亡率为8.8%。术后并发症包括17例（8.5%）患者发生截瘫，5例（2.5%）患者发生中风，5例（2.5%）患者发生需要透析的急性肾衰竭。逻辑回归分析显示，截瘫发生的显著因素为术前低血压（p = 0.005，比值比18.5）、术中低血压（p = 0.001，比值比77.6）和开放远端吻合技术（p = 0.012，比值比4.6）。
我院术后截瘫的预测因素为围手术期低血压和开放远端吻合技术。避免这些危险因素可能会降低术后截瘫的发生率。
