Lüke P, Abicht J, Rehm M, Tsilimparis N, Azad S C
Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
Interdisziplinäre Schmerzambulanz und Tagesklinik Großhadern, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland.
Anaesthesist. 2020 Oct;69(10):765-778. doi: 10.1007/s00101-020-00836-0.
During surgical repair of aortic pathologies (e.g. dissection, aneurysms), cross-clamping of the aorta or overstenting of critical segmental arteries can lead to ischemia- and edema-related spinal cord damage with subsequent paraplegia. By regulating cerebrospinal fluid pressure, the spinal catheter is an effective method for prophylaxis and treatment of spinal cord ischemia. Due to the high complication rate of the spinal catheter a detailed risk-benefit assessment is obligatory: besides cerebrospinal fluid leakage, postpuncture headaches and local infections, feared complications, such as intracranial bleeding, meningitis and neuraxial hematomas can also occur, sometimes with a significant latent period after termination of the procedure. Adequate training of personnel in the perioperative handling of spinal catheters and meticulous adherence to drainage parameters are important components for increasing procedural safety. This is particularly true since the clinical aspects of catheter-associated complications only slightly differ from that of ischemic spinal cord injury.
在主动脉病变（如夹层、动脉瘤）的手术修复过程中，主动脉交叉钳夹或关键节段动脉的过度支架置入可导致与缺血和水肿相关的脊髓损伤，继而导致截瘫。通过调节脑脊液压力，脊髓导管是预防和治疗脊髓缺血的有效方法。由于脊髓导管的并发症发生率较高，必须进行详细的风险效益评估：除了脑脊液漏、穿刺后头痛和局部感染外，还可能发生颅内出血、脑膜炎和椎管内血肿等令人担忧的并发症，有时在手术结束后有很长的潜伏期。对工作人员进行脊髓导管围手术期处理的充分培训以及严格遵守引流参数是提高手术安全性的重要组成部分。这一点尤为重要，因为导管相关并发症的临床症状与缺血性脊髓损伤的症状仅有轻微差异。
