选择性肋间动脉灌注在主动脉手术中的脊髓保护作用

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。

Spinal cord protection of selective intercostal arterial perfusion during aortic surgery

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.