及时插管及呼吸功能预测对急性外伤性颈脊髓损伤的价值

Timely intubation with early prediction of respiratory exacerbation inacute traumatic cervical spinal cord injury

目的本研究旨在确定颈脊髓损伤患者未常规插管后呼吸功能恶化的预测因素以明确及时插管的价值。方法通过回顾性分析本院2015年1月~2021年12月急诊就诊的未常规插管的急性创伤性颈脊髓损伤患者临床资料,将其分为颈脊髓损伤后呼吸恶化后意外紧急插管组与未插管组,比较两组基线资料特征和创伤严重程度。通过单因素分析比较两组间的治疗数据和临床结果。此外,对临床重要的自变量如完全运动损伤、损伤节段位于C_(5)以上水平、肺不张和大量气道分泌物进行多因素Logistic回归分析。结果106中,59例(55.7%)需要伤后插管,2例(1.9%)在住院期间死亡。22例(20.8%)伤后平均3.5 d发生呼吸恶化;38例C_(5)水平以上的完全运动损伤患者中,8例(21.1%)发生呼吸恶化并紧急插管。50例发生完全运动损伤的患者中,有11例(38%)发生呼吸恶化并紧急插管。多因素分析证实,大量气道分泌物是呼吸恶化的独立预测因素(OR=8.69,95%CI=3.46~40.28,P<0.01)。结论在C_(5)以上运动完全损伤的急性期3 d内,在密切关注气道分泌物的基础上及时插管,可以预防呼吸恶化,减少不必要的侵入性气道控制。

Objective To determine the predictive factors for respiratory function deterioration in patients with cervical spinal cord injury without routine intubation,in order to clarify the value of timely intubation.Methods A retrospective analysis was conducted on the clinical data of acute traumatic cervical spinal cord injury patients who received emergency treatment in our hospital from January 2015 to December 2021 without conventional intubation.They were divided into two groups:the emergency intubation group and the non intubation group after respiratory deterioration after cervical spinal cord injury.The baseline data characteristics and trauma severity of the two groups were compared.Treatment data and clinical outcomes were compared between the two groups through univariate analysis.In addition,multivariate logistic regression analysis was conducted on clinically important independent variables such as complete exercise injury,injury segment above C_(5)level,atelectasis,and a large amount of airway secretion.Results Among 106 cases,59(55.7%)required post injury intubation,and 2(1.9%)died during hospitalization.22 cases(20.8%)experienced respiratory deterioration on average 3.5 days after injury.Among 38 patients with complete exercise injury above C_(5)level,8(21.1%)experienced respiratory deterioration and urgent intubation.Out of 50 patients with complete exercise injury,11(38%)experienced respiratory deterioration and urgent intubation.Multivariate analysis confirmed that a large amount of airway secretions was an independent predictor of respiratory deterioration(OR=8.69,95%CI=3.46-40.28,P<0.01).Conclusion In the acute phase of complete injury caused by exercise above C_(5),timely intubation based on close monitoring of airway secretions can prevent respiratory deterioration and reduce unnecessary invasive airway control within three days.