高压氧联合治疗性低温用于血管内修复胸主动脉瘤后脊髓缺血的逆转
Reversal of Spinal Cord Ischemia Following Endovascular Thoracic Aortic Aneurysm Repair With Hyperbaric Oxygen and Therapeutic Hypothermia.
作者信息
Urquieta Emmanuel, Varon Joseph, Lin Peter H
机构信息
1 Division of Aerospace Medicine, Department of Internal Medicine, Wright State University, Dayton, OH, USA.
2 Division of Critical Care Medicine, Department of Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.
出版信息
Vasc Endovascular Surg. 2017 Oct;51(7):517-520. doi: 10.1177/1538574417725238. Epub 2017 Aug 18.
BACKGROUND
Neurological adverse events with spinal cord ischemia (SCI) remain one of the most feared complications in patients undergoing thoracic endovascular aortic repair (TEVAR). These patients can develop irreversible paraplegia with lifelong consequences with physical and psychological agony.
CASE PRESENTATION
We herein present a patient who developed SCI with bilateral lower leg paraplegia on the third postoperative day following TEVAR. Spinal catheter was inserted for spinal fluid drainage. A hyperbaric oxygen therapy was initiated for 90 minutes for 2 days, which was followed by therapeutic hypothermia for 24 hours with a target temperature of 33°C. The patient exhibited significant neurological recovery following these treatments, and he ultimately regained full neurological function without spinal deficit.
DISCUSSION
This represents the first reported case of full neurological recovery of a patient who developed complete SCI following TEVAR procedure. The neurological recovery was due in part to immediate therapeutic hypothermia and hyperbaric oxygen therapy which reversed the spinal ischemia.
背景
脊髓缺血（SCI）导致的神经系统不良事件仍是接受胸段血管腔内主动脉修复术（TEVAR）患者最令人担忧的并发症之一。这些患者可能会发展为不可逆的截瘫，给身体和心理带来终身痛苦。
病例介绍
我们在此报告一名患者，在TEVAR术后第三天出现SCI并伴有双侧小腿截瘫。插入脊髓导管进行脑脊液引流。开始进行为期2天、每次90分钟的高压氧治疗，随后进行24小时的治疗性低温，目标温度为33°C。经过这些治疗，患者的神经功能有显著恢复，最终完全恢复神经功能，无脊髓功能缺损。
讨论
这是首例报道的TEVAR术后发生完全性SCI患者实现完全神经功能恢复的病例。神经功能恢复部分归因于立即进行的治疗性低温和高压氧治疗，它们逆转了脊髓缺血。
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