在开放和内血管胸腔腹腔大动脉修复中进行神经监测的实践 - - 一项国际专家基础的修改后的德尔菲共识研究
Thomas Schachner1, Roman Gottardi2,3, Jürg Schmidli4
1University Clinic of Cardiac Surgery and University Clinic of Vascular Surgery, Innsbruck Medical University, Innsbruck, Austria.
概括
在胸腔腹腔大动脉瘤 (TAAA) 修复过程中保护脊髓至关重要. 虽然在开放的TAAA修复中广泛使用,但神经保护策略在内血管TAAA修复中不太常见,但应考虑广泛的程序.
科学领域:
- 心血管外科心血管外科
- 神经外科 神经外科
- 血管外科 血管外科
背景情况:
- 脊髓损伤 (SCI) 是开放或内血管胸腔腹腔大动脉瘤 (TAAA) 修复后的重大并发症.
- 当前在TAAA修复期间的神经保护的实践和标准尚未统一确立.
研究的目的:
- 收集有关接受开放和内血管TAAA修复的患者目前神经保护实践的信息.
- 通过修改的Delphi方法建立关于神经保护标准的共识.
主要方法:
- 一项国际在线调查是由大动脉协会对TAAA修复中的神经监测进行的.
- 一个专家小组开发了一项调查,随后对18个关键问题进行了修改的Delphi共识.
主要成果:
- 56名医生做出了反应;45名医生进行了开放式和内血管TAAA修复.
- 大脑脊髓液 (CSF) 排水 (97.9%) 和近红外光谱 (70.8%) 在开放的TAAA修复中很常见.
- 脑脊液排水 (92.5%) 在内血管TAAA修复中很常见,但其他方式的使用较少,有3个中心不使用保护.
结论:
- 在开放TAAA修复过程中脊髓保护的重要性方面存在广泛的共识.
- 神经保护措施在内血管TAAA修复中未得到充分利用,但建议对大动脉进行广泛覆盖.
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