急性颈髓损伤患者继发肺部感染高危因素的回顾性研究

Retrospective analysis of the risk factors for secondary pulmonary infection after cervical spinal cord injury

目的回顾性分析急性外伤性颈髓损伤患者继发肺部感染的高危因素。方法收集符合标准的脊髓损伤患者共154例,获取其病历资料中的性别、年龄、损伤原因、损伤节段、损伤平面和是否合并椎体骨折或脱位等相关临床资料,根据是否发生肺部感染分成对照组120例和病例组34例,对2组患者的临床资料进行单因素分析和Logistic回归分析。结果154例患者中,继发肺部感染34例。年龄[比值比(OR)=0.953,95%可信区间(CI)(0.913~0.995)]、美国脊柱损伤学会(ASIA)分级A级[OR=17.013,95%CI(5.187~55.801)]、C_(4)及以上损伤[OR=3.225,95%CI(1.236~8.414)]、损伤至救治时间>8 h[OR=4.010,95%CI(1.447~10.887)]是继发肺部感染的危险因素。结论年龄、ASIA分级A级、高位脊髓损伤、损伤至救治时间>8 h是急性外伤性颈髓损伤后继发肺部感染的危险因素,对患者进行高危因素评估并进行早期预防性护理或干预,有望降低其肺部感染发生率,进而减少损伤后的死亡率。

Objective To analyze retrospectively the risk factors for pulmonary infection after traumatic cervical spinal cord injury.Methods The 154 patients with a cervical spinal cord injury studied included 120 with a pulmonary infection and 34 uninfected controls.Regressions were evaluated using data on their genders,ages,the cause of injury,affected segments,the neurological level of the injury(NLI),and the presence of a vertebral fracture or dislocation.Results Age,complete injury,NLI at C_(1) to C_(4),and an injury-to-treatment time of more than 8 hours were found to be independent risk factors for secondary pulmonary infection.Conclusion Elderly spinal cord injury patients,with a complete injury,an NLI between C_(1) and C_(4) or an injury-to-treatment time of more than 8 hours have a higher risk of pulmonary infection.