呼吸道系统管理模式对降低颈脊髓完全损伤气管切开风险的意义

Strengthened respiratory management for lower tracheostomy risks in patients with complete cervical spinal cord injury

目的 分析通过呼吸道系统管理模式降低颈脊髓完全损伤气管切开率的可行性.方法 回顾性分析2006至2012年上海长征医院骨科239例采用呼吸道系统管理模式的颈脊髓完全损伤病例的临床资料包括年龄、性别、受伤原因、颈髓损伤节段、手术情况、气管切开情况及预后情况,统计气管切开率及死亡率,并与1991至2005年大宗病例的回顾性研究数据进行比较.对严重颈脊髓损伤我院近年采用了呼吸道系统管理模式,包括强化体内充足能量及水份、预防或解除支气管痉挛、稀释痰液、加强翻身拍背、经鼻吸痰管或纤支镜吸痰、深呼吸及咳嗽训练、严格气管切开指征、必要时术后可短时间保留气管插管.结果 32例患者被实施气管切开,气管切开率12.6％.10例死亡,死亡率为4.2％.而1991至2005年的气管切开率为19.1％,死亡率为21.4％.颈脊髓完全损伤气管切开率较前明显降低,而存活率明显提高.结论 合理的呼吸道系统管理模式可有效降低颈脊髓完全损伤的气管切开率,提高救治存活率.

Objective To access the feasibility of reducing tracheostomy rates in patients with complete cervical spinal cord injury through a systemic respiratory management mode.Methods A retrospective review was performed for 239 patients on a systemic respiratory management mode after complete cervical spinal cord injury in Shanghai Changzheng Hospital from 2006 to 2012.Their demographic and clinical data,including age,gender,cause of injury,level of cervical spinal cord injuries,surgical approaches,tracheostomy rates and mortality rates,were collected and analyzed.Tracheostomy rates were compared with those of patients with complete cervical spinal cord injury.Tracheostomy rates were compared with those patients with complete cervical spinal cord injury from 1991 to 2005.The new respiratory management mode for patients with severe cervical spinal cord injury included maintaining adequate energy and water for patients,relieving bronchospasm,loosening phlegm,strengthening body-turning and backslapping,sputum aspiration with suction tube through nasal cavity or bronchofibroscope,strengthening deep breath and cough training,strict control of tracheostomy indications and short-term postoperative intubation reserving if necessary.Results 32 patients were implemented tracheostomy.The tracheostomy rate was 13.4％.10 patients died,the mortality rate was 4.18％.However,the tracheostomy rate was 19.1％ and mortality rate 21.4％ from 1991 to 2005.The tracheostomy rate was significantly lower than before and survival rate improved significantly.Conclusion The systemic respiratory management mode can effectively reduce tracheostomy rate of patients with complete cervical spinal cord injury and improve their survival rate.