外伤性颈髓损伤患者早期并发症与损伤程度的相关性

Correlation between complications and injury degree in patients with acute traumatic cervical spinal cord injury

中文关键词:  颈髓损伤  损伤程度  并发症  相关性

英文关键词:Cervical spinal cord injury  Injury degree  Complication  Correlation

中文摘要:

  【摘要】 目的：调查不同程度颈脊髓损伤（CSCI）患者早期并发症的发生情况，探讨颈髓损伤严重程度与并发症发生的相关性。方法：2005年1月~2009年5月我院收治CSCI早期患者325例，除外20例因各种原因住院时间<7d的患者，共有305例患者入选。男249例，女56例；年龄14～83岁，平均45岁；伤后距来院就诊时间0.5h～20d，住院时间7～45d，平均为23d。高处坠落伤111例，车祸伤85例，摔伤75例，重物砸伤15例，原因不明损伤19例。按ASIA分级：A级132例，B级26例，C级89例，D级58例。按损伤程度将患者分为A（A级）、B（B级）、C（C级）、D（D级）4组，对4组患者早期并发症发生情况进行统计和分析。结果：305例患者共发生13种并发症，其中便秘229例次（75.08%），心率减慢144例次（47.21%），低钠血症137例次（44.92%），高热124例次（40.46%），呼吸功能障碍104例次（34.10%），血压下降94例次（30.82%），低蛋白血症83例次（27.21%），贫血72例次（23.61%），消化功能障碍70例次（22.95%），低钾血症45例次（14.75%），压疮38例次（12.46%），泌尿系感染28例次（9.18%），下肢深静脉血栓9例次（2.95%）。便秘、下肢深静脉血栓的发生率4组间无显著性差异（P>0.05），其余并发症的发生率4组间均有显著性差异（P<0.05）；除便秘、压疮、泌尿系感染、下肢深静脉血栓外，并发症发生率均为A组>B组>C组>D组，且A、B组明显高于C、D组。结论：颈脊髓损伤患者早期并发症较多；除便秘、压疮、泌尿系感染、下肢深静脉血栓外，其余并发症的发生率随着损伤程度加重而增高，A?鄄SIA分级A、B级患者的发生率明显高于C、D级患者。

英文摘要:

  【Abstract】 Objectives: To investigate the incidence of complications in patients with different degrees of cervical spinal cord injury(CSCI), and to explore the correlation of severity and complications. Methods: 325 CSCI patients suffering from acute spinal cord injury in our hospital from January 2005 to May 2009 were reviewed retrospectively. A total of 305 patients were selected, while 20 patients of hospital stay <7d were excluded in this study. There were 249 males and 56 females, with a mean age at injury of 45 years old(range, 14-83 years old), the interval between treatment and injury was 0.5h to 20d, and hospital stay was 7-45d(average, 23d). The pathology included high fall injury in 111 cases, traffic accident in 85 cases, fall injury in 75 cases, heavy weight injury in 15 cases and unknown injury in 19 cases. According to the ASIA classification: there were 132 cases of grade A, 26 grade B, 89 grade C and 58 grade D. The patients were divided into A(grade A), B(grade B), C(grade C), D(grade D) groups according to injury severity, and the incidences of complications in four groups were statistically analyzed. Results: A total of 13 complications occurred in 305 patients, which included 229 cases(75.08%) with constipation, 144 cases(47.21%) with heart rate decline, 137 cases(44.92%) with hyponatremia, 124 cases(40.46%) with high fever, 104 cases(34.10%) with respiratory dysfunction, 94 cases(30.82%) with blood pressure decreasing, 83 cases(27.21%) with hypoproteinemia, 72 cases(23.61%) with anemia, 70 cases(22.95%) with digestive dysfunction, 45 cases(14.75%) with hypokalemia, 38 cases(12.46%) with pressure ulcers, 28 cases(9.18%) with urinary tract infection and 9 cases(2.95%) with deep vein thrombosis. The incidences of constipation and deep venous thrombosis among the four groups showed no significant difference(P>0.05); while the incidences of remaining complications were different among the four groups(P<0.05). Except constipation, pressure sores, urinary tract infection and DVT, the incidence of other complications in group A was >group B, >group C and >group D. Conclusions: The incidence of complications is high for CSCI patients, which is positively correlated with the degree of injury except constipation, pressure sores, urinary tract infection and DVT, and the incidence of complications in grade A and B is significantly higher than grade C and D.