急性重度颈脊髓损伤患者临床特征及早期死亡的危险因素分析

Analysis of clinical characteristics and risk factors of early death in patients with acute severe cervical spinal cord injury

目的探讨重度创伤性颈脊髓损伤患者临床特点及早期死亡的危险因素。方法分析2015年1月-2020年5月在本院治疗的急性重度外伤性颈脊髓损伤患者457例,按照早期死亡(30 d内)与否分为观察组和对照组,统计其性别、年龄、体质量指数、致伤因素、损伤节段、AISA分级、合并伤、基础疾病、是否手术、手术时机等指标,纳入Logistic回归分析探讨其早期死亡危险因素。结果457例患者30 d以内死亡83例,病死率为18.16%,单因素分析发现:年龄、损伤节段、APACHEⅡ评分、受伤至手术时间、肺部感染、气管插管、低钠血症、血白蛋白等因素的组间差异有统计学意义(P<0.05)。多因素分析发现,低白蛋白血症(OR=1.906,P=0.016),高APACHEⅡ评分(OR=9.643,P=0.004),肺部感染(OR=4.976,P=0.038),高损伤节段(OR=10.933,P=0.045),低钠血症(OR=2.103,P=0.021)是急性重度颈脊髓损伤患者早期死亡的危险因素,及早手术(OR=0.887,P=0.013)是其保护性因素。结论高损伤节段、APACHEⅡ评分、肺部感染等反映病情严重程度和并发症的相关指标,对患者早期死亡的预测具有重要意义,而及早手术能够降低早期死亡率。

Objective To explore the clinical characteristics of patients with severe traumatic cervical spinal cord injury,and to analyze the risk factors that may affect their early death,thus to provide reference for preventive treatment.Methods The clinical characteristics of 457 patients with severe cervical spinal cord injury admitted to our hospital from January 2015 to May 2020 were analyzed.The patients died within 30 days or not were assigned into the observation group or the control group.The sex,age,body mass index,injury factors,injured segment,AISA grade,combined injuries,basic disease,surgery or not,timing of surgery were observed,and Logistic regression analysis was used to analyzed the risk factors of early death.Results Among 457 patients with acute traumatic cervical spinal cord injury,83 patients died within 30 days,and the early death rate was 18.16%.Univariate regression analysis showed that age,the injured segments,APACHEⅡscore,the time from injury to surgery,pulmonary infection,orotracheal intubation,hyponatremia,albumin had significant differences between the two groups(P<0.05).The multi-factor regression analysis found that hypoalbuminemia(OR=1.906,P=0.016),the high injured segments(OR=10.933,P=0.045),high APACHEⅡscore(OR=9.643,P=0.004),pulmonary infection(OR=4.976,P=0.038),hyponatremia(OR=2.103,P=0.021)were risk factors for the early death of patients with acute severe traumatic cervical spinal cord injury(P<0.05),and early operation(OR=0.887,P=0.013)was the protective factor of early death.Conclusion The factors reflecting disease severity and occurrence of related complications such as the high injured segments,APACHEⅡscore,pulmonary infection,are important in predicting the early death among patients with acute severe traumatic cervical spinal cord injury,while early operation can decrease the rate of the early death.