Coselli Joseph S, LeMaire Scott A, Orozco-Sevilla Vicente, Preventza Ourania, Moon Marc R, Barron Lauren M, Chatterjee Subhasis
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
The Texas Heart Institute, Houston, TX, USA.
Ann Cardiothorac Surg. 2023 Sep 28;12(5):429-437. doi: 10.21037/acs-2023-scp-10. Epub 2023 May 4.
Spinal cord deficit (SCD) is a feared complication after thoracoabdominal aortic aneurysm repair. Vigilant management throughout the perioperative period is necessary to reduce the risk of SCD. Measures for preventing SCD during the intraoperative period include preoperative optimization and recognizing patients at a higher risk of SCD. In this manuscript, we discuss intraoperative adjuncts including utilization of cerebrospinal fluid drainage, left heart bypass, mild hypothermia, selective reimplantation of intercostal and lumbar arteries, and renal and visceral vessel perfusion. From the operative to the postoperative period, careful attention to avoiding hypotension and anemia is important. If SCD is recognized early, therapeutic intervention may be implemented to mitigate injury.
脊髓功能缺损（SCD）是胸腹主动脉瘤修复术后令人担忧的并发症。在围手术期进行 vigilant 管理对于降低 SCD 风险是必要的。术中预防 SCD 的措施包括术前优化以及识别 SCD 风险较高的患者。在本手稿中，我们讨论了术中辅助措施，包括脑脊液引流的应用、左心转流、轻度低温、肋间动脉和腰动脉的选择性再植入以及肾和内脏血管灌注。从手术期到术后，仔细注意避免低血压和贫血很重要。如果早期识别出 SCD，可实施治疗干预以减轻损伤。 （注：vigilant 此处可能有误，推测原文可能是“vigilant”，正确的可能是“vigilant”，意为“警惕的”，这里暂按原文翻译）
