严重颈髓损伤早期救治措施探讨

Early treatment of severe injury of cervical spinal cord

目的探讨目前主要治疗措施对严重颈髓损伤患者早期生存（外伤后1个月）的作用。方法对532例严重颈髓损伤患者（脊髓损伤ASIA分级中的A级和B级）的临床资料进行详尽的收集整理，通过Logistic回归确定主要救治措施：伤后颈椎临时稳定、手术、气管切开、全身营养支持、糖皮质激素与患者早期生存的相关性；然后将Logistic回归确定的相关治疗措施与患者早期生存率之间的关系情况列表；讨论分析上述救治措施存在的问题。结果438例严重颈髓损伤患者获得早期生存。颈椎手术、全身营养支持与患者早期生存呈正相关，气管切开与早期生存呈负相关，其他两个因素与患者早期生存无显著相关性。严重脊髓损伤患者手术组的早期生存率为93．5％，非手术组为32．7％；营养支持良好患者早期生存率为97．8％，营养支持较差患者为66．7％；气管切开组的早期生存率为58．1％，未切开组为87．5％。结论积极的手术治疗和良好的全身营养支持有助于提高严重颈髓损伤患者的早期生存率；不适当的气管切开将增加颈髓损伤患者早期死亡的危险；糖皮质激素对于严重脊髓损伤患者的早期生存无显著作用。

Objective To investigate the effects of current major management strategies on early survival of patients with severe injury of cervical spinal cord. Methods A retrospective analysis was done on 532 patients with severe injury of cervical spinal cord （American Spinal Injury Association Grades A and B）. The correlations of the early survival and major treatment measures, post-injury temporary immobilization of neck, operation, tracheotomy, systemic nutritional support, administration of glucocorticoid, were analyzed by Binary Logistic Regression. The problems related to the major treatment measures were also analyzed. Results 438 cases survived within 1 month. There was a positive correlation between the early survival and operation and nutritional support. There was a negative correlation between the early survival and tracheotomy. There was not any significant correlation between the early survival and the other 2 measures. The early survival rate for patients of operation was 93.5%, for those without operation was 32. 7%, for those of good nutrition was 97.8%, for those without good nutrition was 66. 7%, for those of tracheotomy was 58.1%, and for those without tracheotomy was 87.5%. Conclusions For patients with severe injury of cervical spinal cord, active operation and fine systemic nutritional support may increase early survival rate, undue tracheotomy may increase the risk of early death, and glucocorticoid may not have an effect on improvement of early survival rate.