Prophylactic cerebrospinal fluid drainage reduces paraplegia after extensive thoracoabdominal aortic aneurysm repair
10.3760/cma.j.issn.1001-4497.2017.02.003
- VernacularTitle:预防性脑脊液测压引流在胸腹主动脉替换手术中的脊髓保护作用
- Author:
Rong WANG
;
Wei SHANG
;
Yipeng GE
;
Nan LIU
;
Xiaotong HOU
;
Junming ZHU
;
Lizhong SUN
- Keywords:
Aortic diseases;
Cerebrospinal fluid drainage;
Spinal cord injury;
Paraplegia
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2017;33(2):77-80
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the impact of cerebrospinal fluid drain(CSFD) on the incidence of acute spinal cord injury(SCI) following extensive TAAA repair.Methods From February 2009 to July 2016,153 patients underwent extensive TAAA repairs with a consistent strategy of normal thermia,non-circulatory bypass,sequential aortic cross clamping,aortic-lilac bypass,and intercostal artery reconstruction.The repairs were performed with preoperative CSFD (n =78) or without CSFD (n =75).In the former group,CSFD was inserted after the patient has been anaesthetized and continued for 72 hours after surgery.The target CSF pressure was 10 mmHg or less.Results The mean age of patients was (38 ± 10) years and 108 (70.6％) were male.There were 87 (53.8％) patients with previous aortic surgeries and 33 (22％) with Marfan syndrome.The two groups had similar risk factors for paraplegia.Aortic clamp time,operation time and number of reattached intercostal arteries were similar in both groups.In-hospital mortality rates were 1.3％ (one patient) and 6.7％ (five patients) for CSFD and the group without CSFD,respectively (P =0.086).Ten patients (13.3 ％) in the group without CSFD had paraplegia develop.In contrast,only two patients in the CSFD group(2.6％) had postoperative paraplegia(P =0.013).Stepwise logistic regression analysis identified CSFD had spinal cord protection,P =0.026;OR =0.171;95％ CI:0.036-0.809).No patients occurred CSF catheter related complications.Conclusion This randomized clinical trial showed that preoperative CSFD placement could be an effective strategy in preventing SCI following extensive aortic aneurysm repair.Care should be taken to prevent complications related to overdrainage.
