在A型大动脉剖析中术后脊髓损伤的风险因素和预后
Jinhua Wei1, Zhan Hu1, Wei Wang1
1Cardiovascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China.
概括
在A型大动脉剖析 (AAD) 手术后,脊髓损伤 (SCI) 的风险随着更多的细分动脉,更长的低温循环停止 (HCA) 和较低的平均动脉压力 (MAP) 的参与而增加. 这些因素预测了较差的长期结果.
科学领域:
- 心血管外科心血管外科
- 神经学 神经学
- 血管外科 血管外科
背景情况:
- 甲型大动脉解剖 (AAD) 是一种危及生命的疾病,需要手术干预.
- 脊髓损伤 (SCI) 是AAD手术后的严重并发症,影响患者的预后.
- 识别SCI的风险因素对于改善AAD患者的外科治疗结果至关重要.
研究的目的:
- 为了调查与手术后脊髓损伤 (SCI) 相关的风险因素,在接受A型大动脉解剖 (AAD) 手术修复的患者中.
- 为了评估在AAD手术后发展SCI的患者的长期预后.
主要方法:
- 在2013年1月至2021年12月期间接受手术的1647名AAD患者的回顾性分析.
- 在患有SCI (n=58) 和没有SCI的患者之间,人口统计学,手术内和解剖学因素的比较.
- 多变量分析以确定SCI的独立预测因素,并评估长期功能结果.
主要成果:
- 患有SCI的患者有显著更高的肋间和腰部动脉参与的数量.
- 较低的手术内平均动脉压 (MAP) 和较长时间的低温循环停止 (HCA) 与增加的SCI风险有关.
- 多变量分析确定了所涉及的细分动脉数量和HCA持续时间作为积极预测因素,而最低的MAP是SCI的负面预测因素.
结论:
- 在AAD手术中,术后SCI的风险因涉及的细分动脉数量,长时间的HCA持续时间和手术内MAP的减少而增加.
- 患有SCI后的患者经历了显著更糟糕的长期功能结果,通常需要轮椅依赖.
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