完全性颈脊髓损伤呼吸机撤机的条件与技术(附53例报告)

Ventilator weaning of complete cervical spinal cord injury:a report of 53 cases

目的探讨不同平面颈椎外伤伴完全性脊髓损伤患者呼吸机支持的撤机时机、条件与方法。方法总结53例颈椎外伤伴完全性脊髓损伤的呼吸机应用和撤机经验：循序渐进地强化呼吸肌训练及撤机模式。加上充分的营养支持、严格的呼吸道管理等综合治疗与护理，使患者达到完全自主呼吸并顺利撤机。结果53例完全性颈脊髓损伤、使用呼吸机支持者全部安全撤机，并获得良好的长期脱机生存状态。C4及以上平面平均撤机时间61．24d，C4、5间隙平面平均撤机时间25．96d，C5、6-C6、7间隙平面平均撤机时间16．44d，各组撤机时间比较，差异具有统计学意义（P〈0．001）。结论完全性颈脊髓损伤呼吸机应用可通过循序渐进的呼吸肌训练以及撤机模式，加上合理的营养支持、呼吸道管理而顺利撤机；脊髓损伤平面越高撤机时间越长，脊髓损伤平面越低撤机时间越短。

Objective To investigate the time, conditions and methods of ventilator weaning in different level cervical spine trauma with complete spinal cord injury. Methods The weaning experience of treatment of 53 cases of cervical spine trauma combined with complete spinal cord injury with application of ventilator was summarized. The combined niodality therapy and nursing included progressive strengthening of respiratory muscle training and weaning mode, coupled with adequate nutrition support, strict respiratory management, which made patients regain spontaneous breathing completely and smooth weaning. Results Fifty three cases in this group all got safe weaning, and a long-term offline survival. The average weaning time of level C4 and above was 61.24 days, average weaning time of level C4、5 25.96 days, average weaning time of level C5、6-C6、7 was 16.44 days, there was significantly difference in the different weaning time of each group （P 〈0.001）. Conclusion Cervical spine trauma with complete spinal cord injury can get safe weaning and a long-term ottline survival by progressive strengthening of respiratory muscle training and weaning mode, coupled with adequate nutrition support, strict respiratory management; The higher level of spinal cord injury, the longer time of weaning, the lower spinal cord injury, the shorter the time of weaning.