颈椎脊髓损伤顽固性呼吸机依赖因素分析及有效脱机方法  

Effective treatment and analysis on causes of prolonged mechanical ventilation after cervical spinal cord injury

作　　者：徐广辉[1] 满毅[1] 张咏[1] 李振环[1] 潘峰[1] 贾连顺[2] 

机构地区：[1]上海长征医院闸北分院(闸北区中心医院)骨科,上海200070 [2]上海长征医院骨科,上海200003

出　　处：《颈腰痛杂志》2013年第2期105-109,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨颈椎脊髓损伤顽固性呼吸机依赖的影响因素及有效脱机措施。方法回顾性分析本组2003-10-2011-12收治的325例急性颈椎脊髓损伤,其中117例行气管切开及呼吸机辅助呼吸,最终81例顺利脱机,36例产生顽固性呼吸机依赖,脱机困难,分析颈椎MRI等影像学资料,判断颈脊髓损伤平面、以ASIA评分评价瘫痪程度、分析呼吸模式、血气分析指标,分析血检指标评价营养状况、以SPSS 15.0对比分析呼吸机依赖组、非依赖组以上指标差异,对顽固性呼吸机依赖组进行强化营养、调整水电解质平衡、加强呼吸功能定时训练,强化心理素质,增强信心,每日进行定时脱机,每次延长脱机时间直至时间对接、达到完全性脱机。结果 36例顽固性呼吸机依赖最终全部脱机,1例因严重感染最终死亡,脱机救治成功率达到97.2%,其中时间最长1例呼吸机辅助呼吸达到38月,时间最短为7周。结论损伤平面高瘫痪重、营养状态差、电解质紊乱及心理恐惧是颈椎脊髓损伤顽固性呼吸机依赖的影响因素;强化营养、调整电解质平衡,加强呼吸功能定时训练,增强心理素质,循序渐进脱机是有效脱机方法。Objective To explore effective treatment and causes of prolonged mechanical ventilation after cervical spinal cord injury.Methods Retrospectively 325 patients with acute cervical spinal cord injury were analyzed.117 patients were treated with tracheostomy and mechanical ventilation,of which 81 patients recovered from mechanical ventilation and 36 patients suffered from prolonged mechanical ventilation.When the patients were in hospital,respiratory mode and blood gas analysis were recorded and the ASIA score was used to evaluate the degree of paralysis and spinal cord injury level.SPSS 15.0 was used to contrast the difference between the mechanical ventilation dependent group and mechanical ventilation independent group statistically.The patients in mechanical ventilation dependent group were improved the nutrition condition、balanced the water and electrolyte balance、forced respiratory function training timing.Mechanical ventilation off-line was used to the echanical ventilation dependent group and the time lasted longer each time until complete off-line.Results 36 cases with prolonged mechanical ventilation recovered lastly.The achievement ratio was 97.2% and one died for severe infection.The longest time for prolonged mechanical ventilation was 38 monthes and the shortest time was 7 weeks.Conclusion High level injury and severe paralysis、bad nutrition condition、electrolyte disturbances and psychofear are the causes for prolonged mechanical ventilation.Improved nutrition condition、electrolyte balancing、respiratory function training timing、strengthening confidence are effective treatment.

关 键 词：颈脊髓损伤 呼吸功能 气管切开 

分 类 号：R744.2[医药卫生—神经病学与精神病学]