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中华脑血管病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (04) : 373 -378. doi: 10.11817/j.issn.1673-9248.2023.04.012

临床病例研究

主动脉夹层术后并发神经系统并发症二例及文献复习
李安, 张秀萍, 白波, 赵阳, 薛国芳(), 李东芳()   
  1. 030001 太原,山西医科大学第二医院神经内科
  • 收稿日期:2022-12-03 出版日期:2023-08-01
  • 通信作者: 薛国芳, 李东芳
  • 基金资助:
    石药集团中国原创药物研究基金项目(YXSY-2020-40)

Neurological complications after aortic dissection: two cases reports and the literature review

An Li, Xiuping Zhang, Bo Bai, Yang Zhao, Guofang Xue(), Dongfang Li()   

  1. Department of Neurology, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China
  • Received:2022-12-03 Published:2023-08-01
  • Corresponding author: Guofang Xue, Dongfang Li
引用本文:

李安, 张秀萍, 白波, 赵阳, 薛国芳, 李东芳. 主动脉夹层术后并发神经系统并发症二例及文献复习[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 373-378.

An Li, Xiuping Zhang, Bo Bai, Yang Zhao, Guofang Xue, Dongfang Li. Neurological complications after aortic dissection: two cases reports and the literature review[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2023, 17(04): 373-378.

主动脉夹层是由于各种原因导致的主动脉内膜、中膜撕裂,主动脉内膜与中膜分离,血液流入,致使主动脉腔被分割为真腔和假腔。主动脉夹层是死亡风险最高的心血管急症之一,若前48 h内未行手术治疗,其病死率高达50%。近年来随着诊断及外科手术技术的进步,主动脉夹层病死率显著下降。随着生存率的提高,相关研究发现患者预后与夹层术后并发症密切相关,术后并发症严重影响患者术后康复并降低其术后生活质量。神经系统并发症,尤其是缺血性脑卒中、脊髓缺血,是主动脉夹层术后最常见、最严重的并发症,如何预防术后神经系统并发症并降低其发生率已成为目前的研究热点,如何诊断与治疗术后神经系统并发症也受到神经科医师的广泛关注。本文报道2例主动脉夹层术后并发神经系统并发症患者的诊疗过程,并结合文献进行学习,以提高神经科医师对主动脉夹层术后并发神经系统并发症的警惕性与关注度。

Aortic dissection is the tearing of the intima and media of the aorta due to various causes. The intima of the aorta is separated from the media and then blood flows in, resulting in the division of the aortic lumen into true lumen and false lumen. Aortic dissection is one of the cardiovascular emergencies with the highest mortality risk, and the mortality rate is as high as 50% if no surgical treatment is performed within the first 48 hours. In recent years, with the progress of diagnosis and surgical techniques, the case fatality rate of aortic dissection has decreased significantly. With the improvement of survival rate, relevant studies have found that patients' prognosis is closely related to postoperative complications of dissection, which seriously affect patients' postoperative rehabilitation and reduce patients' postoperative quality of life. Neurological complications, especially ischemic stroke and spinal cord ischemia, are among the most common and severe postoperative complications of aortic dissection. How to prevent and reduce the incidence of postoperative neurological complications has become a hot research topic at present. How to diagnose and treat postoperative neurological complications has also attracted extensive attention from neurologists. In this article, we reported the diagnosis and treatment process of two patients with postoperative neurological complications of aortic dissection and reviewed the literature, to improve the vigilance and attention of neurologists on the postoperative neurological complications of aortic dissection.

图1 病例1患者相关影像学检查图像。图a为术后头颅弥散加权成像示右侧额叶、顶叶、枕叶、胼胝体压部、左侧小脑半球异常信号;图b为术后磁共振血管成像示右侧大脑前动脉显影不佳,闭塞可能
图2 病例2患者相关影像学检查图像。图a、b为术前主动脉CT血管成像示主动脉夹层(DeBakey Ⅲ型),主动脉弓至腹主动脉下段可见真假腔形成;图c、d、e为术后头颅弥散加权成像示双侧多发急性期脑梗死;图f为术后胸腰椎磁共振检查示颈7~胸7椎体水平脊髓内异常信号影,考虑脊髓缺血梗死改变;图g、h、i为术后头颅CT血管成像示双侧大脑前、中、后动脉走行正常,未见闭塞和扩张,管壁光滑,密度均匀,造影剂通过顺畅
1
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