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|本期目录/Table of Contents|

选择性肋间动脉灌注在主动脉手术中的脊髓保护作用

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2009年第5期
页码:
709-711
栏目:
临床研究
出版日期:
2009-07-14

文章信息/Info

Title:
Spinal cord protection of selective intercostal arterial perfusion during aortic surgery
作者:
周庆; 武忠; 李庆国; 王东进
南京大学医学院附属鼓楼医院胸心外科，江苏 南京 210008
Author(s):
ZHOU Qing;  WU Zhong;  LI Qing-guo;  WANG Dong-jin
Department of Cardiothoracic Surgery, Affiliated Najing Drumtower Hospital, Medical School, Nanjing University, Nanjing 210008, Jiangsu, China
关键词:
肋间动脉; 脊髓保护; 降主动脉; 外科手术
Keywords:
intercostal artery;  spinal cord protection;  decending aorta;  surgical treatment
分类号:
R61
DOI:
-
文献标识码:
A
摘要:
目的: 观察选择性肋间动脉灌注在降主动脉手术中对脊髓的保护作用。方法: 2004年8月~2007年7月，10例患者（非灌注组）因降主动脉夹层（4例）或降主动脉瘤（6例）行降主动脉置换术，术中切断置换降主动脉的肋间动脉。2007年8月~2008年6月，6例患者（选择性灌注组）因降主动脉夹层（4例）或降主动脉瘤（2例）行降主动脉置换术。术中保留置换降主动脉的所有肋间动脉，进行选择性肋间动脉灌注，减少脊髓缺血时间及程度以达到脊髓保护的目的。术后早期观察和中期随访是否有截瘫发生。结果: 非灌注组术中脊髓缺血时间(28.9±3.6)min，选择性灌注组术中脊髓缺血时间(25.0±1.7)min，非灌注组患者的脊髓缺血时间显著长于选择性灌注组。非灌注组10例患者中1例患者术后出现截瘫，选择性灌注组6例患者术后均无截瘫发生，痊愈出院，选择性灌注组随访4～14个月，患者无远期截瘫发生，生活质量良好。结论: 选择性肋间动脉灌注可缩短脊髓缺血时间和程度，脊髓保护效果良好，并可大大降低手术操作难度。
Abstract:
AIM: To evaluate the efficacy of selective intercostal arterial perfusion in the protection of spinal cord during descending aortic surgery. METHODS: A comparative study was conducted among 10 patients undergoing descending aorta replacement without selective intercostal arterial perfusion and six patients undergoing descending aorta replacement with selective intercostal arterial perfusion. We performed selective intercostal arterial perfusion from the T1 intercostal artery to the T10-11 intercostal artery through a Dacron graft branch to protect the spinal cord from ischemia. The rate of paraplegia was compared between groups after surgery and during follow-up ranging from 4 to 14 months. RESULTS: Mean ischemic duration of non-perfusion group was (28.9±3.6)min (range: 24-36 min). Postoperative paraplegia occurred in one patient after surgery. Mean ischemic duration of selective perfusion group was (25.0±1.7)min (23-27 min) and no postoperative paraplegia occurred post-operatively or during follow-up. CONCLUSION: Selective intercostal arterial perfusion reduces ischemic time and severity of spinal cord injury. This method offers good protection for spinal cord and facilitates surgery.

参考文献/References

［1］ Rahman A, Ustundag B, Burma O, et al. Neuroprotective effect of regional carnitine on spinal cord ischemia-reperfusion injury［J］. Eur J Cardiothorac Surg, 2001, 20(1):65-70.

［2］ Hamilton IN Jr, Hollier LH. Adjunctive therapy for spinal cord protection during thoracoabdominal aortic aneurysm repair［J］. Semin Thorac Cardiovasc Surg, 1998, 10(1):35-39.

［3］ Svensson LG, Crawford ES, HessKR, et al. Experience with 1509 patients undergoing thoracoabdominal aortic operations［J］. J Vasc Surg, 1993, 17(2):357-368.

［4］ Wan IY, Angelini GD, Bryan AJ, et al. Prevention of spinal cord ischaemia during descending thoracic and thoracoabdominal aortic surgery［J］. Eur J Cardiothorac Surg, 2001, 19(2):203-213.

［5］ Koshino T, Murakami G, Morishita K, et al. Does the Adamkiewicz artery originate from the larger segmental arteries?［J］. J thorac Cardiovasc Surg, 1999, 117（5）:898-905.

［6］ Cambria RP, Davison JK, Carter C, et al. Epidural cooling for spinal cord protection during thoracoabdominal aneurysm repair: A five-year experience［J］. J Vasc Surg, 2000, 31（6）:1093-1102.

备注/Memo

备注/Memo:
收稿日期：2008-11-16.通讯作者：王东进，主任医师，博士，主要从事微创心脏外科研究Email:gldjw@163.com 作者简介：周庆，硕士，主治医师Email:zhouqing069@yahoo.com.cn
更新日期/Last Update: 2009-07-22