创伤性颈髓损伤患者气管切开危险因素及相关评分系统的应用价值  

Risk factors of tracheotomy in patients with traumatic cervical spinal cord injury and the application value of related scoring system

作　　者：杨铁柱[1] 刘燕[2] 徐道志[1] 王茜 何冬梅[1] 唐辉[1] 常晖[1] 李良业[1] YANG Tie-zhu;LIU Yan;XU Dao-zhi;WANG Qian;HE Dong-mei;TANG Hui;CHANG Hui;LI Liang-ye(Intensive Care Unit,Luoyang Orthopedic Hospital of Henan Province ( Orthopedic Hospital of Henan Province),Zhengzhou,Henan 450016,China)

机构地区：[1]河南省洛阳正骨医院郑州院区河南省骨科医院重症医学科,河南郑州450016 [2]河南中医药大学研究生院,河南郑州450046

出　　处：《中国临床研究》2019年第6期767-770,774,共5页Chinese Journal of Clinical Research

基　　金：河南省中医药科学研究专项课题(2013zy02010)~~

摘　　要：目的探讨创伤性颈髓损伤患者行气管切开的危险因素,以及相关评分系统的预测价值。方法采用回顾性研究方法,选择2012年7月至2018年2月收治的年龄≥18岁创伤性颈髓损伤患者189例,根据是否行气管切开术分为气管切开组(86例)和非气管切开组(103例),对气管切开术的相关危险因素进行单因素及多因素Logistic回归分析;绘制受试者工作特征曲线(ROC),评价美国脊柱损伤委员会(ASIA)运动和感觉评分、急性生理与慢性健康评分(APACHEⅡ)、损伤严重程度评分(ISS)、临床肺部感染评分(CPIS)对需行气管切开术的预测价值。结果(1)气管切开组与非气管切开组在长期吸烟史、慢性肺病史、脊髓损伤平面及程度、气管插管、肺部感染以及ASIA运动和感觉、APACHEⅡ、ISS、CPIS评分方面,均具有统计学差异(P<0.05,P<0.01),且长期吸烟史、慢性肺病史、脊髓损伤程度重和平面高、气管插管、肺部感染为需行气管切开术的独立性危险因素(P<0.05,P<0.01);(2)长期吸烟史、慢性肺病史、脊髓损伤程度越重和平面越高,气管切开时间越早(P<0.01);合并肺部感染气管切开时间要晚于无肺部感染患者(P<0.01);(3)ROC曲线绘制发现,ASIA运动评分系统预测需气管切开,AUC面积最大(0.995),敏感性最高(0.988),特异性较高(0.961)。结论创伤性颈髓损伤患者行气管切开术存在着其特有的危险因素,合理分析和有效预测,可减少不合理和延迟气管切开,防治肺部感染发生。Objective To explore the risk factors of tracheotomy in patients with traumatic cervical spinal cord injury (TCSCI) and the predictive value of related scoring system. Methods A total of 189 TCSCI patients over 18 years old admitted to hospital from July 2012 to February 2018 were selected and analyzed retrospectively. According to whether or not tracheotomy was performed, the patients were divided into tracheotomy group ( n =86) and non-tracheotomy group ( n = 103). Univariate and multivariate logistic regression analysis were used to analyze the risk factors for tracheotomy. The receive operating characteristic ( ROC) curve was drawn to evaluate the predictive values of American Spinal Injury Association ( ASIA) score of motion and sensation, Acute Physiology and Chronic Health Enquiry Ⅱ( APACHE-Ⅱ) score, Injury Severity Score ( ISS) and Clinical Pulmonary Infection Score ( CPIS ) for tracheotomy. Results ( 1 ) There were significant differences in long-term smoking history, chronic lung disease history, spinal cord injury level and degree, tracheal intubation, pulmonary infection, ASIA motor and sensation, APACHE Ⅱ, ISS, CPIS scores between two groups ( all P < 0. 01 ), and long-term smoking history, chronic lung disease history, spinal cord injury with high level and severe degree, tracheal intubation, pulmonary infection, were the independent risk factors for tracheotomy ( P < 0. 05 ).( 2 ) The longer the history of long-term smoking and chronic lung disease, the heavier the spinal cord injury degree and the higher the spinal cord injury level, the earlier the time for tracheotomy. The time for tracheotomy in patients combined with pulmonary infection was later than that in patients without pulmonary infection (P <0. 05 ).(3) ROC curve plotting showed that ASIA motor scoring system revealed the largest area under curve ( AUC,0. 995),the highest sensitivity (0. 988) and the higher specificity (0. 961 ) in prognostic need for tracheotomy. Conclusion There areunique risk factors of tracheotomy for patient

关 键 词：创伤性颈髓损伤 气管切开 危险因素 ASIA评分 APACHEⅡ 损伤严重程度评分 肺部感染 

分 类 号：K651.2[历史地理—历史学]