Stanford B型急性主动脉综合征腔内修复术后并发脊髓缺血的危险因素分析

Risk factors of spinal cord ischemia after thoracic endovascular aortic repair of Stanford type B acute aortic syndrome

目的探讨Stanford B型急性主动脉综合征(acute aortic syndrome,AAS)TEVAR术后脊髓缺血(spinal cord ischemia,SCI)的危险因素。方法分析2015年1月至2017年12月南京鼓楼医院收治的281例B型AAS患者的临床资料,根据术后SCI发生情况分为SCI组(8例)和对照组(273例),比较两组各因素的差异并进行多因素Logistic回归分析。结果TEVAR术后SCI与AAS病理类型及降主动脉覆盖率密切相关,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,IMH/PAU(OR=6.02,95%CI=4.52~7.01,P=0.018)和长段降主动脉覆盖(覆盖率≥40%)(OR=5.30,95%CI=3.80~6.81,P=0.030)是术后SCI的危险因素。结论IMH/PAU和长段降主动脉覆盖(覆盖率≥40%)为TEVAR术后SCI的危险因素,可作为防治术后SCI的参考指标。

Objective To explore the risk factors of spinal cord ischemia(SCI)after thoracic endovascular aortic repair(TEVAR)in Stanford type B acute aortic syndrome(AAS)patients.Methods The clinical data of 281 patients with type B AAS admitted to Nanjing Drum Tower Hospital between January 2015 and December 2017 were analyzed.According to the occurrence of SCI after operation,patients were divided into SCI group(8 cases)and control group(273 cases).The differences between the two groups were compared and multivariate logistic regression analysis was performed.Results SCI after TEVAR was closely related to pathological type of ASS and coverage of descending aorta,and the difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that IMH/PAU(OR=6.02,95%CI=4.52~7.01,P=0.018)and long descending aortic coverage(coverage rate≥40%)(OR=5.30,95%CI=3.80~6.81,P=0.030)was the risk factors for SCI.Conclusions Pathology of IMH/PAU and long descending aortic coverage(coverage rate≥40%)are the risk factors for SCI after TEVAR in patients with type B AAS,which can be used as the references for the prevention of SCI after TEVAR.