急性重度外伤性颈脊髓损伤患者早期死亡的危险因素分析  

Analysis of the risk factors for early death in acute severe traumatic cervical spinal cord injury

作　　者：冷玉鑫[1] 聂春艳[1] 姚智渊[1] 朱曦[1] 

机构地区：[1]北京大学第三医院重症医学科,100191

出　　处：《中华危重病急救医学》2013年第5期294-297,共4页Chinese Critical Care Medicine

基　　金：首都医学发展科研基金资助项目（2009-1014）

摘　　要：目的寻找急性重度外伤性颈脊髓损伤患者早期死亡的危险因素。方法回顾性分析1994年1月1日至2012年10月1日本院收治的急性重度外伤性颈脊髓损伤患者的临床资料，按30d内是否死亡分为死亡组和存活组。通过单因素分析和logistic回归分析来寻找影响患者早期死亡的危险因素。结果1093例急性外伤性颈脊髓损伤患者中有352例重度患者纳入本研究，早期病死率为14．49％（51/352）；致伤原因以车祸伤（153例）和摔伤（117例）为主；死亡原因以呼吸衰竭（16例）、多器官功能衰竭（14例）、消化道出血（11例）居多。综合单因素分析和logstic回归分析发现：高急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分[〉15分，优势比（OR）=11．595，P=0．000]、高损伤节段（OR=3．519，P=0．032）、低钠血症（OR=6．316，P=0．000）、神经源性休克（OR=6．209，P=0．000）、肺部感染（OR=14．627，P=0．000）、气管切开（OR=8．983，P=0．000）等因素为重度损伤患者早期死亡的危险因素；而性别，年龄，是否手术，是否存在骨折或脱位、中枢性高热，是否使用糖皮质激素等因素对急性重度颈脊髓损伤患者是否早期死亡无确切影响。结论反映急性重度外伤性颈脊髓损伤患者病情严重程度和并发症的相关指标对预测患者是否早期死亡的意义更大；而年龄、手术等相关因素的影响被削弱。Objective To survey the risk factors for early death of patients with acute severe traumatic cervical spinal cord injury. Methods A retrospective analysis of data of consecutive patients with acute severe traumatic cervical spinal cord injury admitted from January 1st 1994 to October 1st 2012 were made. The patients died within 30 days or not were allocated for death group or survival group. The risk factors for early death were analyzed through univariate analysis and logistic analysis. Results Among 1093 patients with acute traumatic cervical spinal cord injury, 352 patients with severe injury were included, and the early death rate was 14.49% （51/352）. The leading causes of spinal cord injury were vehicle accidents （ 153 cases） and falls （ 117 cases）. The main causes of early death were respiratory failure （ 16 cases）, multiple organ failure （MOF, 14 eases） and gastrointestinal bleeding （ 11 cases）. Combining the results of univariate and logistic analysis, it was found that high acute physiology and chronic health evaluation II （APACHE II ） score ≥15, odds ratio （OR）=11.595, P=0.000], high damage level （OR=3.519, P=0.032）, hyponatremia （OR=6.316, P=0.000）, neurogenie shock （OR=6.209, P=0.000）, pulmonary infection （OR= 14.627, P=0.O00） and tracheostomy （OR=8.983, P=0.O00） were risk factors for early death of patients with acute severe traumatic cervical spinal cord injury, however, the impact of gender, age, surgery, fracture and dislocation, high central fever, and administration of steroids on early death of patients with acute severe traumatic cervical spinal cord injury were uncertain. Conclusion The factors reflecting disease severity and occurrence of related complications were more important in predicting the early death among patients with acute severe traumatic cervical spinal cord injury, while the influence of age, surgical manipulation etc. were minor factors.

关 键 词：脊髓损伤 重度 颈部 危险因素 

分 类 号：R651[医药卫生—外科学]