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Abstract：
Background: Spinal cord ischemia (SCI) is a severe complication after fenestrated/branched endovascular repair (f/bEVAR). The underlying causes of SCI are still under investigation. This study aimed to evaluate intra- and early post-operative parameters that may affect SCI evolution. Methods: A single-center retrospective analysis was conducted including SCI patients with complete anesthesiologic records (1 January 2011 to 31 December 2023). Values of intra-operative glucose, hemoglobin, lactate, activated clotting time (ACT), and the need for transfusion were collected. The cohort was compared to a matched cohort of non-SCI patients. Results: Fifty-one patients with SCI and complete anesthesiologic records were included (mean age: 69.8 ± 6.2 years; 39.2% male). Intra-operative glucose value < 110 mg/dL (AUC: 0.73; sensitivity 91%, specificity of 83%) and hemoglobin value > 8.5 mg/dL (AUC: 0.61; sensitivity 83%, specificity 78%) were protective for Grade 3 SCI. Twenty-three patients with SCI were matched to 23 patients without SCI. SCI patients presented significantly higher glucose levels intra-operatively (glucose mean value: SCI 150 ± 46 mg/dL vs. non-SCI: 122 ± 30 mg/dL, p = 0.005). ACT (SCI 259 ± 31 svs. non-SCI 288 ± 28 s, p = 0.001), volume input (SCI 4030 ± 1430 mL vs. non-SCI 3020 ± 113 mL, p = 0.009), and need for transfusion (SCI: 52.5% vs. 4.3%, p < 0.001) were related to SCI. Higher glucose levels were detected among patients with SCI, at 24 (SCI: 142 ± 30 mg/dL vs. non-SCI: 118 ± 26 mg/dL, p=0.004) and 48 h (SCI: 140 ± 29 mg/dL vs. non-SCI: 112 ± 20 mg/dL, p < 0.001) post-operatively. Conclusions: SCI is a multifactorial complication after f/bEVAR. Intra-operative and early post-operative glucose levels may be related to SCI evolution. Targeted glucose < 110 mg/dL may be protective for Grade 3 SCI.
摘要：
背景：脊髓缺血（SCI）是开窗/分支血管内修复（f/bEVAR）后的严重并发症。SCI的根本原因仍在调查中。本研究旨在评估可能影响SCI演变的术中和术后早期参数。方法：单中心回顾性分析纳入有完整麻醉记录的SCI患者（2011年1月1日至2023年12月31日）。术中葡萄糖值，血红蛋白,乳酸，激活凝血时间（ACT），收集了输血的需要。将该队列与非SCI患者的匹配队列进行比较。结果：纳入51例SCI患者和完整的麻醉记录（平均年龄：69.8±6.2岁；39.2％为男性）。术中葡萄糖值<110mg/dL（AUC：0.73；灵敏度为91％，特异性83%）和血红蛋白值>8.5mg/dL（AUC：0.61；灵敏度83%，特异性78%)对3级SCI具有保护性。23例SCI患者与23例无SCI患者相匹配。SCI患者术中血糖水平显着升高（葡萄糖平均值：SCI150±46mg/dL与非SCI：122±30mg/dL，p=0.005)。ACT（SCI259±31svs。非SCI288±28秒，p=0.001),体积输入(SCI4030±1430mL与非SCI3020±113mL，p=0.009),和需要输血(SCI：52.5%vs.4.3%,p<0.001)与SCI相关。在SCI患者中检测到更高的葡萄糖水平，在24（SCI：142±30mg/dLvs.非SCI：118±26毫克/分升，p=0.004）和48h（SCI：140±29mg/dLvs.非SCI：112±20mg/dL，p<0.001)术后。结论：SCI是f/bEVAR术后的多因素并发症。术中和术后早期葡萄糖水平可能与SCI演变有关。目标葡萄糖<110mg/dL可以保护3级SCI。
