胸主动脉腔内修复患者围手术期脊髓缺血评估与管理的最佳证据总结

doi:10.3761/j.issn.2096-7446.2025.06.020

摘要/Abstract

摘要：

目的评价并总结胸主动脉腔内修复（thoracic endovascular aortic repair，TEVAR）患者围手术期脊髓缺血评估及管理的最佳证据。方法系统检索国内外数据库、相关专业网站中关于TEVAR患者围手术期脊髓缺血评估及管理的临床决策、指南、专家共识、系统评价、证据总结、原始研究等，检索时限为2014年1月1日至2024年5月23日。由2名研究者对纳入文献进行质量评价、资料提取、证据分级及汇总。结果共纳入15篇文献，包括临床决策1篇、指南5篇、专家共识6篇、系统评价2篇、队列研究1篇。从多学科团队、危险因素评估、术中脊髓保护、术后脊髓缺血评估、术后集束化措施、脑脊液穿刺引流、康复7个方面汇总了27条推荐意见。结论该研究全面、科学地汇总了TEVAR患者围手术期脊髓缺血评估及管理的相关证据，为临床医护人员有针对性地开展证据应用提供循证依据。

关键词: 胸主动脉腔内修复, 脊髓缺血, 评估, 管理, 证据总结, 循证护理研究

Abstract:

Objective To evaluate and summarize the best evidence for the assessment and management of perioperative spinal cord ischemia（SCI） in patients with thoracic endovascular aortic repair（TEVAR）. Methods The databases at home and abroad and relevant professional websites were systematically searched for clinical decision-making，guidelines，expert consensus，evidence summaries，and original studies on the assessment and management of perioperative SCI in patients with TEVAR. The retrieval time limit was from January 1，2014 to May 23，2024. Two researchers performed quality assessment，data extraction，evidence grading and summarization of the included literature. Results A total of 15 studies were included，including one clinical decision，five guidelines，six expert consensuses，two systematic reviews，and one cohort study. Twenty-seven recommendations were summarized in seven areas，including multidisciplinary team，assessment of risk factors，intraoperative spinal cord protection，assessment of spinal cord ischemia，postoperative cluster measures，cerebrospinal fluid puncture and drainage，and rehabilitation. Conclusion This study comprehensively and scientifically summarizes the best evidence for the assessment and management of spinal cord ischemia after TEVAR，provides an evidence-based basis for clinical healthcare professionals to target the application of evidence.

Key words: Thoracic Endovascular Aortic Repair, Spinal Cord Ischemia, Assessment, Management, Evidence Summary, Evidence-Based Nursing

向玉萍, 邓志强, 曾玲, 范景秀. 胸主动脉腔内修复患者围手术期脊髓缺血评估与管理的最佳证据总结[J]. 中华急危重症护理杂志, 2025, 6(6): 744-750.

XIANG Yuping, DENG Zhiqiang, ZENG Ling, FAN Jingxiu. Best evidence summary for prevention and management of spinal cord ischemia after thoracic endovascular aortic repair[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(6): 744-750.

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