急性颈脊髓损伤发热原因识别及处理  

Determination and treatment for fever origin in acute cervical spinal cord injury

作　　者：赖必华[1] 吴建斌[1] 高招文[1] 连伟飞[1] 

机构地区：[1]福建医科大学附属南平市第一医院骨二科,福建南平353001

出　　处：《临床骨科杂志》2015年第4期418-421,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨急性颈脊髓损伤发热原因的诊断和治疗策略。方法对38例急性颈脊髓损伤伴发热患者(术后吸收热除外)的临床资料进行回顾性研究,分析发热原因、发热持续时间,明确诊断所需时间、处理措施及临床转归情况。结果急性颈脊髓损伤发热原因:肺部感染16例,植物神经功能紊乱7例,尿路感染5例,胸腔积液3例,切口感染2例,食管瘘、鼻窦炎、压疮伴感染、上消化道穿孔及下肢深静脉血栓各1例。鼻窦炎所致发热持续时间及明确诊断所需时间最长,分别为11 d及9 d,压疮伴感染所致发热持续时间及明确诊断时间最短,分别为2 d及1 d。5例死亡发热患者中,3例为肺部感染,1例为上消化道穿孔,1例为植物神经功能紊乱。其余患者给予相应处理后体温均正常。结论急性颈脊髓损伤发热常见原因有肺部感染、植物神经功能紊乱及尿路感染,应警惕发热可能掩盖的致死性疾病,明确诊断后给予针对病因治疗。Objective To explore the cause of fever in acute cervical spinal cord injury （ ACSCI） patients and clini-cal treatment. Methods 38 cases of clinical data of acute cervical spinal cord injury patients with fever were re-viewed. The cause of fever,duration of fever was analyzed and recorded,the time for diagnosis,the treatment and clini-cal outcomes of fever was required. Results The causes of fever in ACSCI included 16 cases of pneumonia,7 cases of autonomic dysfunction,5 cases of urinary tract infections,3 cases of pleural effusionin,2 cases incision infection,e-sophageal fistulathe, sinusitis, pressure ulcers with infection, upper gastrointestinal perforation and deep vein throm-bosis in 1 case. The longest duration of fever and time required for diagnosis were fever resulted from sinusitis with re-spectively 11 days and 9 days. The shortest were fever caused from decubitus with infection with respectively 2 days and 1 day. There were 5 patients died among whom 3 patients with pneumonia,1 with upper gastrointestinal perfora-tionand and 1 with autonomic dysfunction. Others patients temperature was back to normal after treatment. Conclu-sions The cause of fever in ACSCI is complicated,including pneumonia,autonomic dysfunction and urinary tract in-fections. The rare cause of fever can not be neglected and it′s necessary to identify the fever overshadowed by fatal dis-eases. Treatment for the cause should be taken after diagnosis.

关 键 词：发热 急性颈脊髓损伤 肺部感染 尿路感染 植物神经功能紊乱 

分 类 号：R683.2[医药卫生—骨科学] R653.1[医药卫生—外科学]