[1]李强,朱曦,幺改琦,等.急性重度颈脊髓损伤患者早期死亡影响因素的初步分析[J].中国微创外科杂志,2009,09(9):802-805.
　Li Qiang,Zhu Xi,Yao Gaiqi,et al.Primary Study of the Factors Causing Early Death in Patients with Acute Severe Cervical Spinal Cord Injury[J].Chinese Journal of Minimally Invasive Surgery,2009,09(9):802-805.
点击复制

急性重度颈脊髓损伤患者早期死亡影响因素的初步分析()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
09
期数:
2009年9期
页码:
802-805
栏目:
出版日期:
2009-09-30

文章信息/Info

Title:
Primary Study of the Factors Causing Early Death in Patients with Acute Severe Cervical Spinal Cord Injury
作者:
李强; 朱曦; 幺改琦; 伊敏; 葛庆岗
北京大学第三医院危重医学科，北京100191
Author(s):
Li Qiang;  Zhu Xi;  Yao Gaiqi;  et al.
Surgical Intensive Care Unit, Peking University Third Hospital, Beijing 100191, China
关键词:
颈脊髓损伤; 早期死亡; 相关因素
Keywords:
Cervical spinal cord injury; Early death; Risk factors
分类号:
R651.2
文献标志码:
A
摘要:
目的探讨导致急性重度颈脊髓损伤患者早期死亡的影响因素。方法回顾性分析2003年1月～2007年12月78例急性重度颈脊髓损伤（ASIA A级和ASIA B级）的临床资料。按照患者是否于受伤后30天内死亡分为早期死亡组和早期存活组。分析患者年龄、损伤节段、损伤至入院时间、减压内固定手术、损伤至手术时间、神经源性休克、中枢性高热、低钠血症、血白蛋白、血淋巴细胞百分比、气管切开、肺部感染12项指标。结果死亡组高损伤节段（C1～C4）患者比例（8/9）高于存活组（49/69）（χ2=18.086，P=0.000），死亡组受伤至手术时间（1～12 d，中位数2 d）少于存活组（1～39 d，中位数3 d)（Z=-2.664，P=0.008）,死亡组出现神经源性休克比例（4/9）高于存活组（6/69）（χ2=12.392，P=0.000）,死亡组出现低钠血症比例（4/9）高于存活组（19/69）(χ2=4.526,P=0.033),死亡组入院时血淋巴细胞百分比（11.84±5.80）%低于存活组（19.17±16.64）%（t=-4.006,P=0.000）,死亡组气管切开患者比例（7/9）高于存活组（10/69）（χ2=29.749,P=0.000）,死亡组并发肺部感染患者比例（8/9）高于存活组（15/69）（χ2=17.266,P=0.000）。结论影响急性重度颈脊髓损伤患者早期死亡的因素是多方面的，患者损伤节段高（C1～C4）、并发神经源性休克、肺部感染、行气管切开术可能是导致患者早期死亡的影响因素。
Abstract:
ObjectiveTo study the causes of early death of patients with acute severe cervical spinal cord injury.MethodsA retrospective analysis was done on 78 cases of acute severe cervical spinal cord injury, who were treated in our hospital between January 2003 and December 2007. The patients were divided into death group and survival group (survived more than 30 days after the injury). The clinical data including age, level of spinal cord injury, time of injury and admission, surgical treatment, duration between injury and surgery, neurogenic shock, central hyperthermia, hyponatremia, serum level of albumin, percentage of lymphocytes in serum, tracheotomy, and pulmonary infection, were recorded and analyzed. ResultsThe proportion of highlevel spinal cord injures (C1-C4) in death group (8/9) was significantly higher than that in the survival group (49/69, χ2=18.086, P=0.000).Whereas the duration between injury and surgery in the death group was significantly shorter than that in the survival group (1-12 d, median 2 d vs 1-39 d, median 3 d; Z=-2.664, P=0.008) . In the death group, 4 of the 9 patients had neurogenic shock, and 4 developed hyponatremia, which were significantly more than those in the survival group (6/69, χ2=12.392, P=0.000; 19/69, χ2=4.526, P=0.033). The percentage of peripheral lymphocyte on admission was (11.84±5.80)% in the death group, which was significantly lower than that of the survival group (19.17±16.64)% (t=-4.006, P=0.000). In the death group, 7 patients received tracheotomy, and 8 patients showed pulmonary infection, the proportions were significantly higher than those in the survival group (10/69, χ2=29.749, P=0.000; and 15/69, χ2=17.266, P=0.000).ConclusionsSeveral factors, including highlevel injury (C1-C4), neurogenic shock, pulmonary shock, and tracheotomy, may cause the death of patients with acute severe cervical spinal cord injury in an early stage.

参考文献/References:

[1]Sokolowski MJ,Jackson AP,Haak MH,et al.Acute mortality and complications of cervical spine injuries in the elderly at a single tertiary care center.J Spinal Disord Tech,2007,20(5):352-356.
[2]关骅,陈学明.脊髓损伤ASIA神经功能分类标准(2000年修订).中国脊柱脊髓杂志,2001,11(3):164.
[3]中华人民共和国卫生部．医院感染诊断标准(试行)．中华医学杂志,2001,81:314-320．
[4]叶添文,贾连顺.早期脊髓复苏在急性颈脊髓损伤治疗中的意义.中国脊柱脊髓杂志,2005,15(12):709-712.
[5]Como JJ,Sutton ER,McCunn M,et al.Characterizing the need for mechanical ventilation following cervical spinal cord injury with neurologic deficit.J Trauma,2005,59(4):912-916.
[6]朱巍，贾连顺，邵将,等.颈椎脊髓损伤早期死亡时限分布.中华医学杂志,2007,87(33):2342-2345.
[7]Jackson AP,Haak MH,Khan N,et al.Cervical spine injuries in the elderly:acute postoperative mortality.Spine,2005,30(13):1524-1527.
[8]肖建如，陆永坚，魏运栋,等.急性颈髓损伤并发MSOF的类型及原因分析.中国矫形外科杂志,1998,5(4):318-319．
[9]O′Keeffe T,Goldman RK,Mayberry JC,et al.Tracheostomy after anterior cervical spine fixation.J Trauma,2004,57(4):855-860.
[10]DeVivo MJ,Kartus PL,Stover SL, et al.Cause of death for patients with spinal cord injuries.Arch Intern Med,1989,149:1761-1766.
[11]Fernando LV,Jennifer B,Amie BJ,et al.Combined medical and surgical treatment after acute spinal cord injury:results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management.J Neurosurg,1997,87(2):239-246.
[12]Tuli S,Tuli J,Coleman WP,et al.Hemodynamic parameters and timing of surgical decompression in acute cervical spinal cord injury.J Spinal Cord Med,2007,30(5):482-490.
[13]McKinley W,Meade MA,Kirshblum S,et al.Outcomes of early surgical management versus late or no surgical intervention after acute spinal cord injury.Arch Phys Med Rehabil,2004,85(11):1818-1825.
[14]张延龄.创伤后的免疫学反应.国外医学·外科学分册,2002,29(3):135-137.
[15]Peruzzi WT,Shapiro BA,Meyer PR.Hyponatremia in acute spinal cord injury.Crit Care Med,1994,22(2):252-258.

更新日期/Last Update: 2014-01-08