Abstract：
OBJECTIVE: To investigate the risk factors and prognosis of spinal cord injury (SCI) after surgical procedure in type A aortic dissection (AAD).
METHODS: Between January 2013 and December 2021, a total of 1647 patients with AAD underwent surgical procedure. Postoperative SCI occurred in 58 patients, including 24 patients with paraplegia and 34 patients with paraparesis. Factors associated with SCI were identified through comparison between patients with and without SCI.
RESULTS: The mean age was 48.8 ± 10.8 years for patients with SCI and 50.1 ± 12.1 years for those without SCI (P = 0.43), with a comparable gender distribution. Median numbers of intercostal and lumbar arteries with involvement were significantly higher in the SCI group (both P < 0.001). The highest (P = 0.033) and lowest (P = 0.001) levels of intraoperative mean arterial pressure (MAP) were significantly lower in the SCI group. Multivariable analysis revealed the number of segmental arteries involved (odds ratio = 1.14, 95% CI 1.08-1.20, P = 0.000), and the duration of hypothermic circulatory arrest (HCA) (odds ratio = 1.04, 95% CI 1.01-1.08, P = 0.042) was positively associated with the occurrence of SCI. Conversely, the lowest level of MAP was negatively associated with SCI (odds ratio = 0.98, 95% CI 0.96-0.99, P = 0.031). During the long-term follow-up, 14 patients with paraplegia needed a wheel chair, while only 1 patient with paraparesis needed one (P < 0.001).
CONCLUSIONS: The risk of postoperative SCI increases when AAD patients experience segmental arteries involved, longer HCA duration and decreased intraoperative MAP during operation.
METHODS: Between January 2013 and December 2021, a total of 1647 patients with AAD underwent surgical procedure. Postoperative SCI occurred in 58 patients, including 24 patients with paraplegia and 34 patients with paraparesis. Factors associated with SCI were identified through comparison between patients with and without SCI.
RESULTS: The mean age was 48.8 ± 10.8 years for patients with SCI and 50.1 ± 12.1 years for those without SCI (P = 0.43), with a comparable gender distribution. Median numbers of intercostal and lumbar arteries with involvement were significantly higher in the SCI group (both P < 0.001). The highest (P = 0.033) and lowest (P = 0.001) levels of intraoperative mean arterial pressure (MAP) were significantly lower in the SCI group. Multivariable analysis revealed the number of segmental arteries involved (odds ratio = 1.14, 95% CI 1.08-1.20, P = 0.000), and the duration of hypothermic circulatory arrest (HCA) (odds ratio = 1.04, 95% CI 1.01-1.08, P = 0.042) was positively associated with the occurrence of SCI. Conversely, the lowest level of MAP was negatively associated with SCI (odds ratio = 0.98, 95% CI 0.96-0.99, P = 0.031). During the long-term follow-up, 14 patients with paraplegia needed a wheel chair, while only 1 patient with paraparesis needed one (P < 0.001).
CONCLUSIONS: The risk of postoperative SCI increases when AAD patients experience segmental arteries involved, longer HCA duration and decreased intraoperative MAP during operation.
摘要：
目的：探讨A型主动脉夹层(AAD)术后脊髓损伤(SCI)的危险因素及预后。
方法：2013年1月至2021年12月，共有1647例AAD患者接受了外科手术。58例患者术后出现SCI,其中截瘫患者24例,截瘫患者34例。通过对有和无SCI患者的比较，确定了与SCI相关的因素。
结果：SCI患者的平均年龄为48.8±10.8岁，非SCI患者的平均年龄为50.1±12.1岁（P=0.43），具有可比的性别分布。SCI组的肋间动脉和腰动脉受累的中位数明显高于SCI组（均P<0.001）。SCI组的术中平均动脉压（MAP）最高（P=0.033）和最低（P=0.001）水平明显较低。多因素分析显示，受累的节段动脉数量（比值比[OR]=1.14，95％CI1.08-1.20，P=0.000）和低温循环停（HCA）持续时间（OR=1.04，95％CI1.01-1.08，P=0.042）与SCI的发生呈正相关。相反，最低MAP水平与SCI呈负相关(OR=0.98,95%CI0.96～0.99,P=0.031)。在长期随访中，14名截瘫患者需要轮椅，而只有1例轻瘫患者需要1例(P<0.001)。
结论：当AAD患者经历节段性动脉受累时，术后SCI的风险增加，较长的HCA持续时间，术中MAP下降。
方法：2013年1月至2021年12月，共有1647例AAD患者接受了外科手术。58例患者术后出现SCI,其中截瘫患者24例,截瘫患者34例。通过对有和无SCI患者的比较，确定了与SCI相关的因素。
结果：SCI患者的平均年龄为48.8±10.8岁，非SCI患者的平均年龄为50.1±12.1岁（P=0.43），具有可比的性别分布。SCI组的肋间动脉和腰动脉受累的中位数明显高于SCI组（均P<0.001）。SCI组的术中平均动脉压（MAP）最高（P=0.033）和最低（P=0.001）水平明显较低。多因素分析显示，受累的节段动脉数量（比值比[OR]=1.14，95％CI1.08-1.20，P=0.000）和低温循环停（HCA）持续时间（OR=1.04，95％CI1.01-1.08，P=0.042）与SCI的发生呈正相关。相反，最低MAP水平与SCI呈负相关(OR=0.98,95%CI0.96～0.99,P=0.031)。在长期随访中，14名截瘫患者需要轮椅，而只有1例轻瘫患者需要1例(P<0.001)。
结论：当AAD患者经历节段性动脉受累时，术后SCI的风险增加，较长的HCA持续时间，术中MAP下降。
