Safi H J, Winnerkvist A, Miller C C, Iliopoulos D C, Reardon M J, Espada R, Baldwin J C
Department of Surgery, Baylor College of Medicine and The Methodist Hospital, Houston, Texas 77030, USA.
Ann Thorac Surg. 1998 Oct;66(4):1204-9. doi: 10.1016/s0003-4975(98)00781-4.
In previous studies of the neurologic outcome of patients undergoing thoracoabdominal aortic aneurysm repair with the simple cross-clamp technique, cross-clamp time of greater than 30 minutes was identified as an important risk factor. We retrospectively examined the effect of clamp time of 30 minutes or greater on outcome for patients undergoing repair with the addition of surgical adjuncts.
Between February 1991 and June 1996 we operated on 370 patients for thoracoabdominal or descending thoracic aortic aneurysm. Two hundred seventy-one of these patients with cross-clamp times of 30 minutes or greater were included in this study. One hundred twelve patients underwent simple cross-clamp repair, whereas 159 were operated on with the surgical adjuncts of distal aortic perfusion and cerebrospinal fluid drainage.
By multivariate analysis, acute dissection, surgical adjuncts, and aneurysm extent proved most significant in overall patient outcome. The overall rate of early neurologic deficits was 23 of 271 (8.5%). For highest risk patients with type II thoracoabdominal aortic aneurysms, the rate of neurologic deficits was 11 of 29 (38%) for cross-clamp versus 6 of 82 (7.3%) for adjunct operation patients (odds ratio = 0.13; p < 0.001).
The adjuncts of cerebrospinal fluid drainage and distal aortic perfusion decreased the risk of extended cross-clamp time during thoracoabdominal aortic aneurysm repair, particularly for highest risk type II.
在先前关于采用单纯交叉钳夹技术进行胸腹主动脉瘤修复患者神经学转归的研究中，交叉钳夹时间超过30分钟被确定为一个重要危险因素。我们回顾性研究了钳夹时间30分钟或更长时间对接受手术辅助治疗的修复患者转归的影响。
1991年2月至1996年6月期间，我们对370例胸腹或降主动脉瘤患者进行了手术。其中271例交叉钳夹时间30分钟或更长时间的患者纳入本研究。112例患者接受单纯交叉钳夹修复，而159例患者接受了远端主动脉灌注和脑脊液引流的手术辅助治疗。
通过多因素分析，急性夹层、手术辅助治疗和动脉瘤范围对总体患者转归最为显著。早期神经功能缺损的总体发生率为271例中的23例（8.5%）。对于最高风险的II型胸腹主动脉瘤患者，交叉钳夹组神经功能缺损发生率为29例中的11例（38%），而辅助手术组为82例中的6例（7.3%）（优势比=0.13；p<0.001）。
脑脊液引流和远端主动脉灌注辅助治疗降低了胸腹主动脉瘤修复期间延长交叉钳夹时间的风险，特别是对于最高风险的II型患者。
