急性颈椎脊髓损伤并发呼吸功能障碍的早期救治

Early treatment of respiratory dysfunction after acute cervical spinal cord injury

目的探讨急性颈椎脊髓损伤并发呼吸功能障碍的临床特点及早期有效的治疗措施。方法回顾性分析105例急性颈椎脊髓损伤患者的临床资料，分析患者入院时的呼吸模式、血气分析指标，判断患者脊髓损伤平面，以ASIA评分评价瘫痪程度，根据患者颈椎损伤情况及呼吸功能状况行颈部牵引制动、气管切开及呼吸机辅助呼吸、加强翻身拍背及支气管镜吸痰、抗感染、颈椎前后路减压植骨内固定手术等治疗措施。结果出现呼吸功能障碍97例，其中严重呼吸衰竭行气管切开、呼吸机辅助呼吸34例，单纯气管切开48例，15例未气管切开、仅行吸氧及支气管镜吸痰治疗。2例死亡，其中1例肺部严重感染，1例颅脑外伤合并纵隔血肿等多发伤。气管切开、呼吸机辅助呼吸患者全部脱机封管成功。结论急性颈椎脊髓损伤患者应早期进行呼吸功能评估，采用气管切开等进行有效的呼吸道管理，调整患者营养状态并加强抗感染，必要时行颈椎手术等综合治疗。

Objective To explore the clinical characteristics and early effective treatment for respiratory dysfunction after acute cervical spinal cord injury. Methods Retrospectively 105 patients with acute cervical spinal cord injury were analyzed. When the patients were in hospital, respiratory mode and hlood gas analysis were recorded and the ASIA score was used to evaluate the degree of paralysis and spinal cord injury level. According to the respiratory condition and cervical injury, cervical traction and other immobilization were finished. Some patients were operated for incision of trachea and the breath was supported by ventilator. All the patients were turned over and slapped the back in order to excrete phlegm on time. Sometimes bronchial lavage was used to excrete phlegm. Anti - infection was emphasized. Anterior cer- vical diseectomy and fusion or posterior decompression and fusion operation were finished once the respiratory function was stable. Results According to the respiratory mode and blood gas analysis results, 97 cases with respiratory dysfunc- tion were observed. 34 patients with severe respiratory failure were operated with incision of trachea and supported by ventilator. 48 patients were only operated with incision of trachea. 15 patients inhaled oxygen and underwent bronchial lavage, who did not undergo incision of trachea. 2 patients died for severe infection and muhiple injury including eranioeerebral trauma. All the patients with incision of trachea were enveloped the trachea successfully. Conclusion The patients with acute cervical spinal cord injury should be evaluated early. The systematic and effective respiratory tract administration, balancing the nutritional state and strengthening anti - infection, even cervical operation are effective treatment for the respiratory dysfunction.