急性重度颈脊髓损伤患者临床特征分析及远期死亡危险因素初探

Analysis of clinical characteristics and risk factors of long-term death in patients with acute severe cervical spinal cord injury

中文关键词:  脊髓损伤  颈脊髓损伤  临床特征  远期死亡因素

英文关键词:Spinal cord injury  Cervical spinal cord injury  Clinical characteristics  Binary logistic regression analysis

中文摘要:

  【摘要】 目的：总结重度创伤性颈脊髓损伤患者临床特征，分析影响其远期死亡的相关因素。方法：回顾性分析我院2010年1月1日~2018年5月31日收治的207例重度颈脊髓损伤患者临床特点，统计其人口学特征（性别、年龄等）、致伤因素、损伤特点（责任节段、AISA分级、合并伤等）、住院治疗情况（是否手术、手术方式、手术时机等）和并发症以及远期死亡情况，建立二元Logistic回归模型分析远期死亡的危险因素。结果：男性183例，女性24例，男女比例为7.63∶1，年龄15~74岁，平均44.7±13.7岁，以高能量损伤（包括高处坠落、车祸、重物砸伤以及其他复合伤）多见（159例，76.8%），50岁以下患者134例（64.73%），损伤节段C1~C2（3例，1.4%）、C3（28例，13.5%）、C4~C5（124例，58%）、C6（25例，12.1%）、C7（26例，12.6%）、C8（5例，2.4%），所有患者治疗受伤至住院时间3.6±3.5d，住院时间为16.2±16.9d；住院期间以呼吸系统（63例，30.4%）和水电解质紊乱（25例，12.1%）为主要并发症。8年间总死亡率为30.91%（64例），多元Logistic回归分析显示，年龄≥50岁、C1-C4损伤、保守治疗、需要呼吸机辅助呼吸是远期死亡的危险因素（P＜0.05）。结论：重度创伤性颈脊髓损伤常见于中青年男性患者，损伤部位好发于C4、C5节段，以高能量暴力创伤为主；高龄、上颈椎损伤、未行手术减压及合并呼吸功能障碍易导致患者远期死亡。

英文摘要:

  【Abstract】 Objectives: To summarize the clinical characteristics of patients with severe traumatic cervical spinal cord injury, and to analyze the predictive factors that may affect their long-term death, and to provide reference for preventive treatment. Methods: The clinical characteristics of 207 patients with severe cervical spinal cord injury admitted to our hospital from January 1, 2010 to May 31, 2018 were retrospectively analyzed. Demographic characteristics, injury factors, injury characteristics(injury factors, responsibility gaps, AIS grades, combined injuries, etc.), hospitalization and complications, and post-injury death were analyzed. Results: Male and female ratio was 7.63∶1. The average age was 44.72±13.73 years. High energy injury was the main cause of injury (including high fall, car accident, heavy body injury and other combined injuries) (159 cases, 76.8%). In 134 cases(64.73%) of the patients under the age of 50, the injured segments were C1-C2(3 cases, 1.4%), C3(28 cases, 13.5%), C4-C5(124, 58%), C6(25 cases, 12.1%), C7(26 cases, 12.6%), C8(5 cases, 2.4%). All the patients were injured for 3.6±3.5 days and 16.2±16.9 days after admission， and the respiratory system failure (63 cases 30.4%) and water electrolyte disorder (25, 12.1%) were the main complications during the hospitalization. The total mortality was 30.91%(64 cases) in 8 years. Binary logistic regression analysis showed that the age over 50 years old, the C1-C4 injury, the conservative treatment, the ventilator dependence were the risk factors of long-term death(P<0.05). Conclusions: Severe traumatic cervical spinal cord injury is common in young and middle-aged male patients. The injury site occurs in the C4 and C5 segments, mainly due to high-energy violent trauma; advanced age, upper cervical spine injury, no surgical decompression and combined respiratory dysfunction are easy to cause long-term death of the patient.