颈髓损伤患者呼吸系统并发症危险因素分析及其对提高护理干预效果的作用  

Analysis of risk factors of respiratory complications in patients with cervical spinal cord injury and their implications for improving nursing intervention

作　　者：崔怡[1] 邸禄芹[1] 陈彩真[1] 吕红芝[1] 闫晓丽[1] 国春花[1] 丁俊琴[1] Cui Yi;Di Luqin;Chen Caizhen;Lyu Hongzhi;Yan Xiaoli;Guo Chunhua;Ding Junqin.(Nursing Department, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China)

机构地区：[1]河北医科大学第三医院护理部,石家庄050051

出　　处：《中华创伤杂志》2018年第6期546-551,共6页Chinese Journal of Trauma

摘　　要：目的探讨颈髓损伤患者呼吸系统并发症的主要危险因素，为进行早期护理评估及个性化护理干预模式提供依据。方法采用回顾性病例系列研究分析2015年1月-2016年9月收治的303例颈髓损伤患者的临床资料，其中男248例，女55例；年龄14—70岁[（44．9±13．8）岁]。骨折部位：C1～4109例，C5～8194例。美国脊髓损伤协会（ASIA）分级：A级131例，B级26例，c级42例，D级104例。受伤至就诊时间6—48h[（23．2±6．99）h]。分析呼吸系统并发症的相关危险因素，包括患者性别、年龄（分为14—54岁、55～65岁、66～70岁）、职业、住院时间、吸烟史、既往史、ASIA分级（A～D级）、致伤原因、合并症（腹胀、低钠血症、低蛋白血症、贫血）等进行单因素分析。对差异有统计学意义的相关因素进行多因素Logistic回归分析，筛选出呼吸系统并发症的相关危险因素。结果单因素分析显示年龄（55—65岁、66～70岁）、ASIA分级A级和B级、吸烟史、致伤原因、合并症（腹胀、低钠血症、低蛋白血症、贫血）与呼吸系统并发症发生具有相关性（P〈0．05），而性别、职业、住院时间、既往史等与呼吸系统并发症发生无关（P〉0．05）。多因素Logistic回归分析结果显示，年龄55～65岁（OR=3．989，P〈0．05）和66～70岁（OR=0．301，P〈0．05）、ASIA分级A级（OR=30．300，P〈0．05）和B级（OR=5．784，P〈0．05）、吸烟史（OR=5．238，P〈0．05）、腹胀（OR=1．975，P〈0．05）、低蛋白血症（OR=6．212，P〈0．05）、低钠血症（OR=3．233，P〈0．05）是颈髓损伤患者呼吸系统并发症的独立危险因素。结论年龄（55岁以上）、ASIA分级A级和B级、吸烟史、腹胀、低蛋白血症、低钠血症是造成颈髓损伤患者发生呼吸系统并发症的危险因素，可据此进行早期护理评估，采取个性化的护理措施，减少呼吸系统并发症的Objective To investigate the main risk factors of respiratory complications in patients with cervical spinal cord injury so as to provide reference for early nursing assessment and personalized nursing intervention model. Methods A retrospective case series study was conducted on the clinical data of 303 patients with cervical spinal cord injury admitted to the Third Hospital of Hebei Medical University between January 2015 and September 2016. There were 248 males and 55 females, aged （44.9 ±13.8）years （range, 14-70 years）. There were 109 cases at fracture site C1-4 and 194 cases at C5-8. According to ASIA classification, 131 cases were grade A, 26 cases grade B, 42 cases grade C, and 104 cases grade D. The duration from injury to operation was （23.2 ± 69.9 ）hours （range, 6-48 hours）. Univariate analysis was performed on the risk factors of respiratory complications, including gender,age （14-54, 55-65, and 66-70 years old）, occupation, hospital stay, smoking history, previous history, ASIA grade （grades A to D）, injury cause, complications （abdominal distension, hyponatremia, hypoproteinemia, and anemia）. Multivariate logistic regression was used to analyze the significant risk factors in the univariate analysis so as to further identify risk factors associated with respiratory complications. Results Univariate analysis showed that age （55-65 and 66-70 years ） , ASIA grade A, ASIA grade B, smoking history, injury cause, complications （ abdominal distension, hyponatremia, hypoproteinemia, and anaemia） were related to respiratory complication of patients with cervical spinal cord injury （P 〈0.05）. The gender, occupation, length of hospital stay, and previous history were not associated with respiratory complications of patients with cervical spinal cord injury （P 〉 0.05）. Logistic regression analysis showed that age between 55 and 65 years （ OR = 3. 989, P 〈 0.05） , age between 66 and 70 years（OR = 0. 301, P 〈 0.05）, AISA grade A （ OR = 30. 300, P 〈

关 键 词：颈椎 脊髓损伤 呼吸系统 危险因素 护理 

分 类 号：R473.6[医药卫生—护理学]