上海医学
上海醫學
상해의학
SHANGHAI MEDICAL JOURNAL
2009年
12期
1074-1078
,共5页
岳嘉宁%符伟国%王玉琦%郭大乔%徐欣%陈斌%蒋俊豪%杨珏%史振宇%竺挺%董智慧%石赟%王利新
嶽嘉寧%符偉國%王玉琦%郭大喬%徐訢%陳斌%蔣俊豪%楊玨%史振宇%竺挺%董智慧%石赟%王利新
악가저%부위국%왕옥기%곽대교%서흔%진빈%장준호%양각%사진우%축정%동지혜%석빈%왕리신
胸主动脉腔内修复术%主动脉夹层%主动脉瘤%脑脊液%脊髓缺血
胸主動脈腔內脩複術%主動脈夾層%主動脈瘤%腦脊液%脊髓缺血
흉주동맥강내수복술%주동맥협층%주동맥류%뇌척액%척수결혈
Thoracic endovascular aortic repair%Aortic dissection%Aortic aneurysm%Cerebrospinal fluid%Spinal cord ischemia
目的 评价脑脊液压力监测及引流在胸主动脉腔内修复术中的应用及其对脊髓缺血的保护作用.方法 共8例患者接受围术期脑脊液压力监测及引流治疗,其中5例为主动脉夹层综合征,3例为主动脉瘤.术前行蛛网膜下隙置管,检测并记录脑脊液压力的基础水平.支架释放后记录脑脊液压力峰值,对压力升高30%以上者行脑脊液引流,维持压力至术前基础水平.结果 主动脉夹层综合征患者支架释放后的脑脊液压力升高(42.13±22.51)%,显著高于主动脉瘤患者的(8.33±4.04)%(P<0.05).其中3例主动脉夹层患者接受脑脊液引流,其余患者仅行脑脊液压力检测.共6例患者接受降主动脉内2枚覆膜支架长节段覆盖,降主动脉被覆膜支架隔绝的长度平均为(24.78±5.11)cm.术后及随访期间,无1例发生截瘫或下肢轻瘫,无中枢感染及低颅压并发症.结论 脑脊液压力监测及引流可安全、有效地预防胸主动脉腔内修复术中及术后脊髓缺血,并可有效避免低颅压并发症的发生.
目的 評價腦脊液壓力鑑測及引流在胸主動脈腔內脩複術中的應用及其對脊髓缺血的保護作用.方法 共8例患者接受圍術期腦脊液壓力鑑測及引流治療,其中5例為主動脈夾層綜閤徵,3例為主動脈瘤.術前行蛛網膜下隙置管,檢測併記錄腦脊液壓力的基礎水平.支架釋放後記錄腦脊液壓力峰值,對壓力升高30%以上者行腦脊液引流,維持壓力至術前基礎水平.結果 主動脈夾層綜閤徵患者支架釋放後的腦脊液壓力升高(42.13±22.51)%,顯著高于主動脈瘤患者的(8.33±4.04)%(P<0.05).其中3例主動脈夾層患者接受腦脊液引流,其餘患者僅行腦脊液壓力檢測.共6例患者接受降主動脈內2枚覆膜支架長節段覆蓋,降主動脈被覆膜支架隔絕的長度平均為(24.78±5.11)cm.術後及隨訪期間,無1例髮生截癱或下肢輕癱,無中樞感染及低顱壓併髮癥.結論 腦脊液壓力鑑測及引流可安全、有效地預防胸主動脈腔內脩複術中及術後脊髓缺血,併可有效避免低顱壓併髮癥的髮生.
목적 평개뇌척액압력감측급인류재흉주동맥강내수복술중적응용급기대척수결혈적보호작용.방법 공8례환자접수위술기뇌척액압력감측급인류치료,기중5례위주동맥협층종합정,3례위주동맥류.술전행주망막하극치관,검측병기록뇌척액압력적기출수평.지가석방후기록뇌척액압력봉치,대압력승고30%이상자행뇌척액인류,유지압력지술전기출수평.결과 주동맥협층종합정환자지가석방후적뇌척액압력승고(42.13±22.51)%,현저고우주동맥류환자적(8.33±4.04)%(P<0.05).기중3례주동맥협층환자접수뇌척액인류,기여환자부행뇌척액압력검측.공6례환자접수강주동맥내2매복막지가장절단복개,강주동맥피복막지가격절적장도평균위(24.78±5.11)cm.술후급수방기간,무1례발생절탄혹하지경탄,무중추감염급저로압병발증.결론 뇌척액압력감측급인류가안전、유효지예방흉주동맥강내수복술중급술후척수결혈,병가유효피면저로압병발증적발생.
Objective To evaluate the protective effect of cerebrospinal fluid pressure monitoring and drainage against spinal cord ischemia during thoracic endovascular aortic repair (TEVAR) in high-risk population. Methods Cerebrospinal fluid (CSF) monitoring and drainage therapy was employed in 8 patients who underwent TEVAR. Five of the 8 patients had thoracic aortic dissection syndrome and 3 had aneurysmal pathology. The peak values of intrathecal pressure were recorded after deployment of the stent grafts and were compared with the baseline values gathered preoperatively. CSF drainage was carried out to maintain the CSF pressure if it exceeded the baseline level by 30%. Results Three of the 5 dissected patients finally exhibited CSF drainage after deployment of the stent grafts. Dissection group demonstrated an increase of the CSF pressure by (42.13± 22.51)% after deployment of the stents; and the increase was significantly higher than that of the aneurysmal group ([8.33±4.04], P < 0.05). Drainage was performed in 3 patients with thoracic aortic dissection syndrome and the other five patients only had their cerebral fluid pressure monitored. Six patients received two overlapped stent grafts in the descending aorta, which resulted in a mean aortic coverage of (24.78±5.11) cm. All patients were neurologically intact during the in-hospital stay and in the subsequent follow-up. Conclusion CSF monitoring and drainage can safely and effectively prevent ischemic injury of spinal cord during TEVAR, and it can also avoid complications such as low intracranial pressure.
