背景:脊髓缺血损伤是主动脉内手术后的严重并发症,发病率低但致残率高。然而,患者通常在疾病的早期阶段没有接受综合治疗。因此,在手术期间和手术后需要积极的神经干预来保护和预防脊髓缺血。在本文中,介绍了2例脊髓缺血性损伤患者的康复方案和影像学资料,并就病因进行了讨论。这种疾病的预防和急性治疗,临床医生可以参考。
方法:病例报告1:一名69岁男性患者在全身麻醉下接受主动脉弓动脉瘤和胸主动脉腔内修复术(覆膜支架)。双下肢完全瘫痪,便秘,术后发生尿潴留,随后转诊至我们的康复科。病例报告2:一名41岁的男子突然出现胸痛,没有头晕或头痛。双下肢的虚弱在30分钟内逐渐出现,随后意识丧失。他被诊断为主动脉夹层,并接受了主动脉支架植入术。出院后3个月开始系统的住院康复。
方法:2例患者均诊断为截瘫和脊髓缺血性损伤。
方法:患者接受力量和转移训练,感官输入,健康使命,和日常生活活动。
结果:患者1在没有辅助设备的情况下返回家中,患者2在轮椅上返回家中。
结论:围手术期脊髓保护与术后生活质量直接相关。一旦出现脊髓缺血性损伤的症状,应尽快进行脑脊液引流,以增加平均动脉压。同时,甲基强的松龙,神经节苷脂,抗凝,血管扩张药物,需要对症支持治疗。必要时重建肋间动脉和锁骨下动脉。症状稳定标志着转诊开始康复。重复功能训练是帮助患者尽快回归家庭和社会的必要条件。
BACKGROUND: Spinal cord ischemia injury is a serious complication after intra-aortic surgery, with a low incidence but high disability rate. However, patients often do not receive comprehensive treatment in the early stages of the disease. Therefore, active neurological intervention is needed to protect and prevent spinal cord ischemia during and after surgery. In this paper, rehabilitation program and imaging data of 2 cases with spinal cord ischemic injury are presented and discussed regarding causes, prevention and acute treatment with this disease, which could be referred by clinicians.
METHODS: Case report 1: A 69-year-old male patient underwent aortic arch aneurysm and thoracic endovascular aortic repair (coated stent) was performed under general anesthesia. Complete paralysis of both lower limbs, constipation, and urinary retention occurred after surgery and was subsequently referred to our rehabilitation department. Case report 2: A man aged 41 years experienced sudden chest pain with no dizziness or headache. Weakness of both lower limbs gradually appeared over 30 minutes with subsequent loss of consciousness. He was diagnosed with aortic dissection and underwent aortic stent implantation. Inpatient rehabilitation began systematically 3 months after discharge.
METHODS: The 2 patients were diagnosed with
paraplegia and spinal cord ischemic injury.
METHODS: The patients received strength and transfer training, sensory input, health mission, and activities of daily living.
RESULTS: Patient 1 returned home without assistive devices and patient 2 returned home with wheelchair.
CONCLUSIONS: Perioperative spinal cord protection is directly related to postoperative quality of life. Once the symptoms of spinal cord ischemic injury occur, cerebrospinal fluid drainage should be performed as soon as possible to increase mean arterial pressure. At the same time, methylprednisolone, ganglioside, anticoagulation, vasodilator drugs, and symptomatic supportive treatments are required. Intercostal artery and subclavian artery are reconstructed if necessary. Symptom stability flags referral to commence rehabilitation. Repetitive functional training is necessary to help patients return to the family and society as soon as possible.