急性创伤性颈髓损伤病人呼吸衰竭危险因素分析  

RISK FACTORS OF RESPIRATORY FAILURE IN PATIENTS WITH ACUTE TRAUMATIC CERVICAL SPINAL CORD INJURY

作　　者：杜佩红 

机构地区：[1]上海市第六人民医院急诊科,上海200233

出　　处：《齐鲁医学杂志》2016年第5期581-583,共3页Medical Journal of Qilu

摘　　要：目的分析急性创伤性颈髓损伤（ATCSCI）并发呼吸衰竭的危险因素,探讨预防干预措施。方法收集2014年6月—2015年6月我院收治的ATCSCI病人468例,其中93例并发呼吸衰竭,375例无呼吸衰竭。比较并发呼吸衰竭和无呼吸衰竭病人的病死率,对ATCSCI早期并发呼吸衰竭的危险因素进行单因素分析和多因素Logistic回归分析。结果并发呼吸衰竭病人病死率为25.8%,高于无呼吸衰竭病人的4.3%（χ^2=44.232,P〈0.05,OR=7.804,95%CI=3.942~15.452）。单因素分析显示,吸烟、早期气管切开、并发肺炎或肺水肿、损伤平面、ASIA分级与并发呼吸衰竭有关（χ^2=4.780~48.675,P〈0.05）;Logistic回归分析显示,吸烟（OR=2.315,95%CI=1.369~4.454）、并发肺炎或肺水肿（OR=5.425,95%CI=1.912~10.774）、损伤平面C_4以上（OR=3.796,95%CI=1.387~6.795）、ASIA高分级（OR=8.120,95%CI=3.574~25.644）是并发呼吸衰竭的危险因素。结论ATCSCI早期并发呼吸衰竭病死率高,吸烟、并发肺炎或肺水肿、损伤平面C_4以上、ASIA分级高可能是ATCSCI早期并发呼吸衰竭的危险因素,临床应采取针对性的干预措施降低风险。Objective To analyze risk factors of respiratory failure in patients with acute traumatic cervical spinal cord injury（ATCSCI）,and discuss their prevention and intervention. Methods Clinical data of 468 ATCSCI patients treated in our hospital,from June 2014 to June 2015,were collected.There were 93 patients with respiratory failure and 375 patients without.The case-fatality rate between patients with respiratory failure and those without was compared.The risk factors of respiratory fai-lure in early stage of ATCSCI were analyzed using single factor analysis and Logistic aggression analysis. Results The fatality rate was 25.8%in patients with respiratory failure,and that in those without was 3%（χ^2=44.232,P〈0.05,OR=7.804,95%CI=3.942-15.452）.Single factor analysis showed that smoking,early tracheotomy,complicated with pneumonia or pneumonedema,damage plane,and ASIA classification were associated with respiratory failure（χ^2=4.780-48.675,P〈0.05）.Logistic aggression revealed that smoking,complicated with pneumonia or pulmonary edema,damage plane above C_4,and high grade ASIA were risk factors contributing respiratory failure（OR=5.425,95%CI=1.912-10.774）. Conclusion The fatality rate is high in ATCSCI patients with early respiratory failure,and smoking,complicated with pneumonia or pulmonary edema,damage plane above C_4 and high ASIA are likely to be risk factors for respiratory failure in early ATCSCI.Clinically,targeted intervention measures should be taken to lower the risks.

关 键 词：脊髓损伤 颈椎 呼吸功能不全 危险因素 

分 类 号：R651.2[医药卫生—外科学] R563.8[医药卫生—临床医学]