Hamilton I N, Hollier L H
Department of Surgery, Chattanooga Unit of the College of Medicine, University of Tennessee 37403, USA.
Semin Thorac Cardiovasc Surg. 1998 Jan;10(1):35-9. doi: 10.1016/s1043-0679(98)70015-2.
Paraplegia, resulting from spinal cord ischemia during thoracoabdominal aortic aneurysm (TAA) repair, continues to be a devastating complication. The incidence of neurological complications, including paraplegia and paraparesis following TAA repair, ranges from 4% to 32% and averages 13% for nondissecting TAA and higher for dissecting TAA. Our current understanding of spinal cord ischemia associated with TAA repair has evolved from animal research and clinical experience. The pathophysiology of spinal cord ischemia is intricately related to three physiological variables. These include the severity and duration of spinal cord ischemia, neuronal reperfusion after reestablishment of spinal cord blood flow, and the neuronal metabolic rate during the ischemic insult. We have developed a multimodality approach to the prevention of neurological deficits, during and after TAA repair, which includes minimizing the severity of spinal cord ischemia, reducing the anticipated reperfusion phenomenon, and lowering the spinal cord metabolic rate. Over the past 16 years, the senior author has undertaken surgical repair of 265 TAAs using a multimodality approach in the protection of spinal cord integrity. In our experience, a combination of adjunctive therapies is critical to minimize the ischemic interval, reduce the neuronal reperfusion injury, and decrease spinal cord metabolism. These techniques have evolved over time, resulting in an overall neurological deficit rate of 4.5% and a neurological deficit at the time of hospital discharge of 1.9%. This article will outline our multimodality approach for spinal cord protection during TAA repair.
在胸腹主动脉瘤（TAA）修复过程中，脊髓缺血导致的截瘫仍然是一种极具破坏性的并发症。TAA修复后包括截瘫和轻截瘫在内的神经并发症发生率在4%至32%之间，非夹层TAA的平均发生率为13%，夹层TAA的发生率更高。我们目前对与TAA修复相关的脊髓缺血的理解源于动物研究和临床经验。脊髓缺血的病理生理学与三个生理变量密切相关。这些变量包括脊髓缺血的严重程度和持续时间、脊髓血流重建后的神经元再灌注以及缺血性损伤期间的神经元代谢率。我们已经开发出一种多模式方法来预防TAA修复期间及之后的神经功能缺损，该方法包括将脊髓缺血的严重程度降至最低、减少预期的再灌注现象以及降低脊髓代谢率。在过去16年中，资深作者采用多模式方法对265例TAA进行了手术修复，以保护脊髓完整性。根据我们的经验，联合辅助治疗对于缩短缺血时间、减少神经元再灌注损伤以及降低脊髓代谢至关重要。这些技术随着时间的推移不断发展，总体神经功能缺损率为4.5%，出院时神经功能缺损率为1.9%。本文将概述我们在TAA修复期间保护脊髓的多模式方法。
