申林娜,王家平,朱榆红

• 1:昆明医学院第二附属医院神经内科
• 2:昆明医学院第二附属医院放射科

摘要(Abstract)：

胸主动脉夹层动脉瘤是一类起病急、病死率高的极其凶险和危重的疾病。由于胸主动脉夹层的神经系统并发症较常见,甚至以首发症状为临床表现者也较多。因此,为了提高对胸主动脉夹层的认识和识别,避免误诊所造成灾难性后果的同时积极治疗胸主动脉夹层。胸主动脉夹层腔内隔绝术的神经系统并发症(如截瘫、脑卒中)也较常见。本文将对胸主动脉夹层合并的神经系统表现、症状和腔内隔绝术治疗胸主动脉夹层围手术期所出现的神经系统并发症的临床表现、预防措施及处理方法进行阐述。

关键词(KeyWords)： 胸主动脉夹层动脉瘤;腔内隔绝术;神经系统并发症;截瘫;缺血性脑卒中

Abstract:

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基金项目(Foundation):

作者(Author): 申林娜,王家平,朱榆红

参考文献(References)：

• [1]Aner J,Berent R.Aortic dissection:incidence nature historyand impact of surgery[J].J Clin Basic Cardiol,2000,3:151-154.
• [2]Kato N,Shimono T,Hirano T,et al.Mideterm results of stent-graft repair of acute and chronic aortic dissection with descend-ing tear:the complication specific approach[J].J Thorac card-iovasc Surg,2002,124(2):306-312.
• [3]景在平,冯翔.胸主动脉夹层动脉瘤微创腔内治疗的基本原则[J].中国实用外科杂志,2000,20(11):692.
• [4]Gaul C,Dietrich W,Friedrich I,et al.Neurological symptomsin typeA aortic dissections[J].Stroke,2007,38(2):292-297.
• [5]Demiryoguran NS,Karcioglu O,Topacoglu H,et al.Painlessaortic dissection with bilateral carotid involvement presentingwith vertigo as the chief complaint[J].Emerg Med J,2006,23(2):15.
• [6]Stanley I,Sharma VK,Tsivgoulis G,et al.Painless aortic dis-sectionwith unusual extension into intracranial internal carotidarteries[J].Cerebrovasc Dis,2007,24(2/3):314-315.
• [7]Alvarez Sabín J,Vázquez J,Sala A,et al.Neurologic manifesta-tions of dissecting aneurysms of the aorta[J].Med Clin(Barc),1989,92(12):447-449.
• [8]Mondon K,Blechet C,Gochard A,et al.Transient global amne-sia caused by painless aortic dissection[J].Emerg Med J,2007,24(1):63-64.
• [9]Khan IA,Nair CK.Clinical,diagnostic,and management per-spectives of aortic dissection[J].Chest,2002,122(1):311-328.
• [10]Parodi JC,Palmaz JC,Barone HD,et al.Transfemoral intralu-minal graft implantation for abdominal aortic aneurysms[J].Ann Vasc Surg,1991,5(6):491-496.
• [11]Dake MD,Miller C,Semba CD,et al.Translrminal placementof endovasavlar stent-grafts for the treatment of descendingthoracic aortic aneurysms[J].N Engl J Med,1994,331(26):1 729-1 734.
• [12]景在平,赵君,冯翔,等.胸、腹主动脉瘤腔内隔绝术的临床应用[J].外科理论与实践,1998,3(4):203-206.
• [13]Bortone AS,De Cillis E,D'Agostino D,et al.Endovasculartreatment of thoracic aortic disease:four years of experience[J].Circulation,2004,110(11 suppl1):Ⅱ262-Ⅱ267.
• [14]Fleck T,Hutschala D,Weissl M,et al.Cerebrospinal fluiddrainage as a useful treatment option to relieve paraplegia af-ter stent-graft implantation for acute aortic dissection type B[J].J Thorac Car-diovase Surg,2002,123:1 003-1 005.
• [15]Tiesenhausen K,Amann W,Koch G,et al.Cerebrospinal fluiddrainage to reverse paraplegia after endovascular thoracic aor-tic aneurysm repair[J].J Endovasc Ther,2000,7:132-135.
• [16]Vaziri ND,Lee YS,Lin CY,et al.NAD(P)Hoxidase,suoerox-ide dismutase,catalase,glutahione peroxidase and nitricoxidesynthase expression in subacate spina cord injury[J].BrainRes,2004,995(1):76.
• [17]王飞,朱庆三,苗旭漫.地尔硫卓、N乙酰半胱氨酸和过氧化氢酶联合应用对脊髓缺血再灌注损伤的保护作用[J].中国老年学杂志,2010,30(6):53.
• [18]祝慧鹏,周艺琳,景在平,等.腹主动脉瘤腔内隔绝术后神经缺血性损伤[J].浙江临床医学,2007,9(2):152-154.
• [19]唐骁,符伟国,郭大乔,等.胸主动脉疾病腔内修复术后并发缺血性脑卒中及其防治探讨[J].外科理论与实践,2007,12(1):38-40.
• [20]Gaul C,Dietrich W,Erbguth FJ.Neurological symptoms inaortic dissection:a challenge for neurologists[J].Cerebro-vasc Dis,2008,26(1):1-8.
• [21]Peterson BG,Eskandari MK,Gleason TG,et al.Utility of leftsubclavian artery revascularization in association with endolu-minal repair of acute and chronic thoracic aotric pathology[J].J Vasc Surg,2006,43(3):433-439.
• [22]Melissano G,Civilini E,Bertoglio L,et al.Endovscular treat-ment of aotric arch aneuyrsms[J].Eur J Vasc EndovascSurg,2005,29(2):131-138.
• [23]Gutsche JT,Cheung AT,McGarvey ML,et al.Risk factors forperioperative stroke after thoracic endovascular aortic repair[J].Ann Thorac Surg JT-The Annals of thoracic surgery,2007,84(4):1 195-1 200.
• [24]管玉龙,董培青,杨绿,等.猪活体脑片钙离子荧光强度的测定及对停循环后脑缺血损伤的评价[J].中华医学杂志,2002,82(1):27-30.
• [25]江朝光,齐弘伟,周春喜,等.深低温停循环时不同脑保护方法对海马区神经元凋亡的影响[J].中华胸心血管外科杂志,2003,19(2):100-102.
• [26]管玉龙,董培青,杨玻,等.中枢神经系统损伤与保护方法的评估[J].中国体外循环杂志,2003,1(2):81-85.