Crawford E S, Mizrahi E M, Hess K R, Coselli J S, Safi H J, Patel V M
Department of Surgery, Baylor College of Medicine, Houston, Texas.
J Thorac Cardiovasc Surg. 1988 Mar;95(3):357-67.
Temporary distal aortic perfusion and somatosensory evoked potential monitoring were attempted prospectively in 198 patients to prevent neurologic complications from occurring after operation for descending thoracic and thoracoabdominal aortic aneurysm. These 198 patients were divided into two groups. Group 1 consisted of 99 (50%) patients in whom adequate (60 mm Hg) distal bypass was achieved and combined with somatosensory evoked potential monitoring. Group 2 consisted of 99 (50%) in whom this could not be achieved. Of the latter, four patients were excluded because of operative death in one and preexisting neurologic deficits in three. The rates of early and delayed neurologic complications were 8% and 12%, respectively, in the former and 7% and 8%, respectively, in the latter. Using the logistic regression method of statistical analysis, adjusting for the difference in patient mix, we found no statistical difference in the incidence of neurologic complications in the two groups. The incidence of false negative somatosensory evoked potential response was 13% and false positive response 67%. Localization of critical spinal arteries for reattachment was not possible. Thus, the method had no significant impact upon the prevention of neurologic deficits, which varied from mild or transient to severe and which either occurred during the operation or were delayed from 12 hours to 21 days.
对198例患者进行了前瞻性的临时降主动脉灌注和体感诱发电位监测，以预防胸降主动脉和胸腹主动脉瘤手术后发生神经系统并发症。这198例患者被分为两组。第一组由99例（50%）患者组成，在这些患者中实现了充分的（60毫米汞柱）远端旁路，并结合了体感诱发电位监测。第二组由99例（50%）患者组成，在这些患者中无法实现这一点。在后者中，有4例患者被排除，原因是1例手术死亡，3例存在既往神经功能缺损。前一组的早期和延迟神经系统并发症发生率分别为8%和12%，后一组分别为7%和8%。使用逻辑回归统计分析方法，对患者构成差异进行校正后，我们发现两组神经系统并发症的发生率没有统计学差异。体感诱发电位反应假阴性发生率为13%，假阳性发生率为67%。无法确定关键脊髓动脉重新附着的位置。因此，该方法对预防神经系统缺损没有显著影响，这些缺损从轻度或短暂性到严重程度不等，要么在手术期间发生，要么延迟12小时至21天出现。
