• 首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院北京市心肺血管疾病研究所心臟外科，北京 100029;

目的探索胸腹主動(dòng)脈瘤手術(shù)患者腦脊液引流（ CSFD）對(duì)脊髓的保護(hù)作用。方法將 2008年 12月至 2009年 8月北京安貞醫(yī)院的 30例胸腹主動(dòng)脈瘤手術(shù)患者，按照術(shù)中是否行 CSFD，采用計(jì)算機(jī)隨機(jī)法分為 CSFD組（15例，其中男 12例，女 3例；平均年齡 45.0歲）和對(duì)照組（ 15例，其中男 11例，女 4例；平均年齡 45.8歲），進(jìn)行升主動(dòng)脈和主動(dòng)脈弓部置換＋降主動(dòng)脈支架植入或胸腹主動(dòng)脈聯(lián)合置換術(shù)，部分患者同時(shí)行 Bentall手術(shù)或半弓置換手術(shù)， CSFD組行 CSFD。術(shù)中和術(shù)后固定時(shí)間點(diǎn)采取血清樣本，測(cè)定其血清 S100B蛋白、神經(jīng)膠質(zhì)原纖維酸性蛋白、神經(jīng)元特異性烯醇化酶，術(shù)前、術(shù)后 72 h和出院時(shí)按美國(guó)國(guó)立衛(wèi)生研究院卒中量表和脊髓損傷神經(jīng)學(xué)分類國(guó)際標(biāo)準(zhǔn)評(píng)分。結(jié)果對(duì)照組 4例出現(xiàn)中樞神經(jīng)系統(tǒng)（ CNS）并發(fā)癥： 1例發(fā)生腦損傷和脊髓損傷而死亡； 1例發(fā)生脊髓損傷，早期行 CSFD等治療，截癱有所恢復(fù)后出院； 2例患者發(fā)生腦損傷，其中 1例死亡，另 1例同時(shí)出現(xiàn)腎功能衰竭和呼吸衰竭等并發(fā)癥，經(jīng)治療后恢復(fù)出院。 CSFD組僅 1例因呼吸衰竭繼發(fā)多器官功能衰竭而死亡，其余患者恢復(fù)良好出院。隨訪 3個(gè)月無死亡。 CSFD組患者血清 S100B（F=7.153，P=0.012）、神經(jīng)膠質(zhì)原纖維酸性蛋白（ F=3.263， P=0.082）和神經(jīng)元特異性烯醇化酶（ F=4.927，P=0.035）值均低于對(duì)照組，且差異有統(tǒng)計(jì)學(xué)意義。結(jié)論腦脊液選擇性引流具有明確的脊髓保護(hù)作用，在胸腹主動(dòng)脈瘤手術(shù)中安全、有效并可行。

引用本文： 鄒以席,黃方炯,孫東等. 胸腹主動(dòng)脈瘤手術(shù)中腦脊液引流對(duì)脊髓的保護(hù)作用. 中國(guó)胸心血管外科臨床雜志, 2012, 19(2): 154-158. doi: 復(fù)制

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2. 　Conrad MF, Crawford RS, Davison JK, et al. Thoracoabdominal aneurysm repair： a 20-year perspective. Ann Thorac Surg, 2007, 83（2）：S856-S861.
3. 　Coselli JS, Bozinovski J, LeMaire SA. Open surgical repair of 2286 thoracoabdominal aortic aneurysms. Ann Thorac Surg, 2007, 83（2）：S862-864.
4. 　Kouchoukos NT, Masetti P, Castner CF. Use of presewn multiple branched graft in thoracoabdominal aortic aneurysm repair. J Am Coll Surg, 2005, 201（4）：646-649.
5. 　Khan SN, Stansby G. Cerebrospinal fluid drainage for thoracic and thoracoabdominal aortic aneurysm surgery. Cochrane Database Syst Rev, 2004, 1：CD003635.
6. 　Cinà CS, Abouzahr L, Arena GO, et al. Cerebrospinal fluid drainage to prevent paraplegia during thoracic and thoracoabdominal aortic aneurysm surgery： a systematic review and meta-analysis. J Vasc Surg, 2004, 40（1）：36-44.
7. 　Hnath JC, Mehta M, Taggert JB, et al. Strategies to improve spinal cord ischemia in endovascular thoracic aortic repair： Outcomes of a prospective cerebrospinal fluid drainage protocol. J Vasc Surg, 2008, 48（4）：836-840.
8. 　Plestis KA, Nair DG, Russo M, et al. Left atrial femoral bypass and cerebrospinal fluid drainage decreases neurologic complications in repair of descending and thoracoabdominal aortic aneurysms. Ann Vasc Surg, 2001, 15（1）：49-52.
9. 　孫衍慶. 胸主動(dòng)脈瘤和主動(dòng)脈夾層動(dòng)脈瘤外科治療不同術(shù)式的評(píng)價(jià). 中國(guó)胸心血管外科臨床雜志, 2003, 10（1）：1-2.
10. 　趙曉琴, 孫立忠, 劉進(jìn). 胸降主動(dòng)脈瘤手術(shù)提高下半身灌注血壓的臨床研究. 心肺血管病雜志, 2000, 19（03）：209-211.
11. 　董培青, 何美玲, 管玉龍, 等. 414例胸主動(dòng)脈瘤手術(shù)的體外循環(huán)經(jīng)驗(yàn). 中華胸心血管外科雜志, 2002, 18（03）：131-133.
12. 　鄒以席，黃方炯. S100B 蛋白作為腦損傷標(biāo)記物的研究進(jìn)展. 中華實(shí)用診斷與治療雜志, 2009, 23（8）：731-734.
13. 　Winnerkvist A, Anderson RE, Hansson LO, et al. Multilevel somatosensory evoked potentials and cerebrospinal proteins： indicators of spinal cord injury in thoracoabdominal aortic aneurysm surgery. Eur J Cardiothorac Surg, 2007, 31（4）：637-642.
14. 　Anderson RE, Winnerkvist A, Hansson LO, et al. Biochemical markers of cerebrospinal ischemia after repair of aneurysms of the descending and thoracoabdominal aorta. J Cardiothorac Vasc Anesth, 2003, 17（5）：598-603.
15. 　Lases EC, Schepens MA, Haas FJ, et al. Clinical prospective study of biochemical markers and evoked potentials for identifying adverse neurological outcome after thoracic and thoracoabdominal aortic aneurysm surgery. Br J Anaesth, 2005, 95（5）：651-661.
  1. 1. 　LeMaire SA, Miller CC 3rd, Conklin LD, et al. Estimating group mortality and paraplegia rates after thoracoabdominal aortic aneurysm repair. Ann Thorac Surg, 2003, 75（2）：508-513.
  2. 2. 　Conrad MF, Crawford RS, Davison JK, et al. Thoracoabdominal aneurysm repair： a 20-year perspective. Ann Thorac Surg, 2007, 83（2）：S856-S861.
  3. 3. 　Coselli JS, Bozinovski J, LeMaire SA. Open surgical repair of 2286 thoracoabdominal aortic aneurysms. Ann Thorac Surg, 2007, 83（2）：S862-864.
  4. 4. 　Kouchoukos NT, Masetti P, Castner CF. Use of presewn multiple branched graft in thoracoabdominal aortic aneurysm repair. J Am Coll Surg, 2005, 201（4）：646-649.
  5. 5. 　Khan SN, Stansby G. Cerebrospinal fluid drainage for thoracic and thoracoabdominal aortic aneurysm surgery. Cochrane Database Syst Rev, 2004, 1：CD003635.
  6. 6. 　Cinà CS, Abouzahr L, Arena GO, et al. Cerebrospinal fluid drainage to prevent paraplegia during thoracic and thoracoabdominal aortic aneurysm surgery： a systematic review and meta-analysis. J Vasc Surg, 2004, 40（1）：36-44.
  7. 7. 　Hnath JC, Mehta M, Taggert JB, et al. Strategies to improve spinal cord ischemia in endovascular thoracic aortic repair： Outcomes of a prospective cerebrospinal fluid drainage protocol. J Vasc Surg, 2008, 48（4）：836-840.
  8. 8. 　Plestis KA, Nair DG, Russo M, et al. Left atrial femoral bypass and cerebrospinal fluid drainage decreases neurologic complications in repair of descending and thoracoabdominal aortic aneurysms. Ann Vasc Surg, 2001, 15（1）：49-52.
  9. 9. 　孫衍慶. 胸主動(dòng)脈瘤和主動(dòng)脈夾層動(dòng)脈瘤外科治療不同術(shù)式的評(píng)價(jià). 中國(guó)胸心血管外科臨床雜志, 2003, 10（1）：1-2.
  10. 10. 　趙曉琴, 孫立忠, 劉進(jìn). 胸降主動(dòng)脈瘤手術(shù)提高下半身灌注血壓的臨床研究. 心肺血管病雜志, 2000, 19（03）：209-211.
  11. 11. 　董培青, 何美玲, 管玉龍, 等. 414例胸主動(dòng)脈瘤手術(shù)的體外循環(huán)經(jīng)驗(yàn). 中華胸心血管外科雜志, 2002, 18（03）：131-133.
  12. 12. 　鄒以席，黃方炯. S100B 蛋白作為腦損傷標(biāo)記物的研究進(jìn)展. 中華實(shí)用診斷與治療雜志, 2009, 23（8）：731-734.
  13. 13. 　Winnerkvist A, Anderson RE, Hansson LO, et al. Multilevel somatosensory evoked potentials and cerebrospinal proteins： indicators of spinal cord injury in thoracoabdominal aortic aneurysm surgery. Eur J Cardiothorac Surg, 2007, 31（4）：637-642.
  14. 14. 　Anderson RE, Winnerkvist A, Hansson LO, et al. Biochemical markers of cerebrospinal ischemia after repair of aneurysms of the descending and thoracoabdominal aorta. J Cardiothorac Vasc Anesth, 2003, 17（5）：598-603.
  15. 15. 　Lases EC, Schepens MA, Haas FJ, et al. Clinical prospective study of biochemical markers and evoked potentials for identifying adverse neurological outcome after thoracic and thoracoabdominal aortic aneurysm surgery. Br J Anaesth, 2005, 95（5）：651-661.