预防性气管切开在颈髓损伤治疗中的应用价值

Value of preventive tracheotomy in patients with acute cervical spinal cord injury

目的探讨预防性气管切开在完全性颈髓损伤患者治疗中的应用价值。方法对2009年1月至2012年12月河北医科大学第三医院创伤急救中心54例外伤所致C4～C8完全性颈髓损伤前路手术患者进行回顾性统计，患者术前均未实施气管切开。对符合预防性气管切开指征的患者在实施颈椎前路手术的同时行气管切开，并据此将患者分为切开组（11例）和未切开组（43例），统计并比较两组的术前时间、住院时间、低氧血症发生率、肺部感染发生率、颈部手术切口感染率、住院期间死亡率。结果预防性气管切开组与未切开组比较，患者的术前时间[（2．9±1．2）d比（5．7±4．4）d]、住院时间[（10．3±4．0）d比（16．5±9．2）d]、低氧血症发生率（9．1％比44．2％）差异有统计学意义。肺部感染发生率（9．1％比7．O％）、颈部手术切口感染率（0比2．3％）、住院期间死亡率（9．1％比27．9％）差异无统计学意义。未切开组患者中有44．2％在术后恢复期由于呼吸困难、低氧血症实施了气管切开或气管插管。结论对呼吸系统条件差、出现呼吸困难可能性大、符合预防性气管切开指征的高危患者实施气管切开可以获得满意的效果。有效改善患者的呼吸功能，降低死亡率；在严格无菌条件下操作，避免伤口感染发生。

Objective To evaluate the value of preventive tracheotomy in patients with acute cervical spinal cord injury. Methods A retrospective analysis was performed on 54 cases of severe C4-C8 cervical spinal cord injury patients undergoing anterior fixation. They were classified as A and B according to the criteria of American Spinal Injury Association. And no tracheotomy was performed preoperatively. The patients with a high risk of dyspnea and with an indication for preventive tracheotomy received a preventive tracheotomy right after anterior fixation. 11 cases were classified into traeheotomy group and 43 cases were in non-tracheotomy group, The preoperative and hospital stays, incidence of hyoxemia and pulmonary infection, incidence of surgical incision site infection and mortality were analyzed between two groups. Results The preoperative and hospital stays of tracheotomy group were shorter than those of non-tracheotomy group （2. 9 ＋ 1.2 vs 5.7 ＋4.4 days, 10. 3 ＋4. 0 vs 16. 5 ＋9.2 days）. The incidence of hyoxemia was lower in tracheotomy group （9. 1% vs 44. 2% ）. There was difference existed between two groups. 44. 2% patients in the non-tracheotomy group underwent tracheotomy or endotracheal intubation for dyspnea and hyoxemia. There was no significant difference between two groups in the incidence of pulmonary infection （9. 1% vs 7. 0% ） or surgical incision site infection （0 vs 2.3% ）. The mortality of non-tracheotomy group was 3.07 folds of that of tracheotomy group （9. 1% vs 27.9% ）. But there was no significant statistical difference. Conclusion The preventive tracheotomy is an effective solution for the patients with respiratory compromises, a high risk of dyspnea and with an indication for preventive tracheotomy. The preventive tracheotomy for severe cervical spinal cord can improve respiratory function effectively and fixation may be performed earlier. And there are lower rates of mortality and infection. [ Key words] Cervical vertebrae; Spinal cord injury ; Therapy; Tracheotomy