ICU内创伤性颈脊髓损伤的流行病学特点分析  

Epidemiology of traumatic cervical spinal cord injury in ICU

作　　者：陈坤[1] 戴建强[1] 张雷[2] 周秋香[3] 林兆奋[3] 李文放[3] 

机构地区：[1]广州军区广州总医院骨科重症监护病房,广州500010 [2]新疆军区总医院重症医学科,乌鲁木齐830000 [3]第二军医大学附属长征医院急救科,上海200003

出　　处：《中华急诊医学杂志》2017年第10期1167-1171,共5页Chinese Journal of Emergency Medicine

基　　金：上海市卫生计生系统重要薄弱学科建设计划（2016ZB0201）;上海市科委国内合作重点项目（14495810400）

摘　　要：目的分析近7年上海长征医院重症监护室收治创伤性颈髓损伤流行病学特征。方法本研究纳入从2010年10月至2016年3月间上海长征医院ICU收治创伤性颈髓损伤（traumatic cervical spinal cord injury, TCSCI）患者，所统计的一般流行病学资料包括：性别、年龄、婚姻状况、职业、病因、损伤节段、损伤严重程度（ASIA分级）、并发症。结果总计纳入病例109例，年龄（53．72±14．86）岁，60～69岁患者最多，达25．69％。患者男女比例为9：1，大部分为已婚患者，退休患者最多为30．27％。道路交通事故及坠落伤是ICU创伤性颈髓损伤患者的主要致伤原因，损伤节段以C5最多，其次为CA。109例患者中30．28％伴多发伤，26．61％的患者存在颅脑损伤。并发症以褥疮和呼吸系统并发症最多，83例患者出现至少一个器官系统的功能障碍，以呼吸系统最为常见，达98．79％，其次是循环系统功能障碍为65．06％，发生两个及两个以上器官系统功能障碍的患者达51例（46．79％）。死亡患者20例，病死率为18．35％。结论交通事故是ICU内TCSCI的主要原因，随着老龄化的加剧，低处坠落也逐渐成为TCSCI的主要致病因素。ICU内的TCSCI患者病死率高，男性患者占绝大多数，并发症发生比例较高，最常见为呼吸系统并发症、电解质紊乱。多器官功能障碍综合征发生率可能与ASIA分级有关。Objective To investigate the epidemiological characteristics of traumatic cervical spinal cord injury （TCSCI） in ICU. Method The data of patients with TCSCI admitted from October 2010 to March 2016 in the intensive care unit were retrospectively studied. The general epidemiological data included： gender, age, marital status, occupation, cause of injury, injury severity, injured segment （ASIA grade）, and complications were collected. Results There were 109 patients identified to have TCSCI with mean age of 53.72±14. 86 years （25.69% patients in the range of 60-69 years old）. The male to female ratio was 9： 1, and the most were married. The majority of individuals were retired （30. 27% ）, and the main causes of injury were traffic accidents and tumble. The C5 segment of the spine was the most vulnerable to be injured, and then the CA segment was the nest in turn. There were up to 30. 28% patients suffered from multiple injuries, and 26.61% patients also had a craniocerebral injury. Bedsore and respiratory system complications were the two leading complications, and 83 patients suffered from at least one system dysfunction with respiratory dysfunction accounted for 98.79% and circulatory dysfunction accounted for 65.06%. Fifty-one patients presented more than two system dysfunctions （46.79%）. Twenty patients （18.35%） died. Conclusion Patients with TCSCI in ICU presented specially characteristic features. Traffic accidents were the main cause of TCSCI, and fall accidents were one of the main causes in the elderly. The mortality of TCSCI was high, especially in males. The compiication rate was relatively high and the most common complications were water and electrolyte disturbance and respiratory dysfunction. Multiple organ dysfunction incidences might be associated with the ASIA grades.

关 键 词：脊髓损伤 创伤性颈髓损伤 流行病学 ASIA分级 交通事故 并发症 多器官功能障碍 病死率 

分 类 号：R181.3[医药卫生—流行病学] R651.2[医药卫生—公共卫生与预防医学]