Tanaka Akiko, Safi Hazim J, Estrera Anthony L
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth) and Memorial Hermann Hospital, 6400 Fannin St., Ste. #2850, Houston, TX, USA.
Gen Thorac Cardiovasc Surg. 2018 Jun;66(6):307-314. doi: 10.1007/s11748-018-0906-1. Epub 2018 Apr 4.
Despite improved survival rates after thoracoabdominal aortic aneurysm repairs, paraplegia remains a devastating complication with high incidence, ranging from 3 to 10%. Ischemic insults to the spinal cord are unavoidable during thoracoabdominal aortic aneurysm repairs. There is no single measure that can prevent paraplegia alone. A multimodality approach is required to minimize the ischemic insults during thoracoabdominal aortic aneurysm repairs and postoperative second hit to the spinal cord. Distal aortic perfusion is important to maintain the collateral network perfusion pressure, while cerebrospinal drainage allows to directly maintain the spinal cord perfusion. Reattachment of segmental arteries T8-T12 is encouraged to lower the incidence of both immediate and delayed paraplegia. Systemic arterial pressure should be maintained above 130 mmHg and cerebrospinal drainage should be continued until the second postoperative day, despite intact neurological status. In this article, we describe our current operative techniques and perioperative management in patients undergoing repairs of thoracoabdominal aortic aneurysm. A review of recent updates on spinal protection strategies is also reported.
尽管胸腹主动脉瘤修复术后生存率有所提高，但截瘫仍然是一种具有高发生率的毁灭性并发症，发生率在3%至10%之间。在胸腹主动脉瘤修复过程中，脊髓缺血损伤是不可避免的。没有单一措施能够单独预防截瘫。需要采用多模式方法，以尽量减少胸腹主动脉瘤修复过程中的缺血损伤以及术后脊髓的二次损伤。远端主动脉灌注对于维持侧支循环网络灌注压力很重要，而脑脊液引流则有助于直接维持脊髓灌注。鼓励重新连接T8 - T12节段动脉，以降低即刻和延迟性截瘫的发生率。尽管神经功能状态完好，全身动脉压应维持在130 mmHg以上，脑脊液引流应持续至术后第二天。在本文中，我们描述了我们目前对接受胸腹主动脉瘤修复患者的手术技术和围手术期管理。还报告了对脊髓保护策略最新进展的综述。
