颈脊髓损伤后长期机械通气依赖性呼吸衰竭的预后因素

Prognostic factors of long-term mechanical ventilation dependent respiratory failure after cervical spinal cord injury

目的探讨颈脊髓损伤后长期机械通气依赖性呼吸衰竭的预后因素。方法选择2018年1月至2021年9月在该院接受减压手术治疗的41例颈脊髓损伤(CSCI)患者作为研究对象,根据是否成功脱机,将患者分为长期机械通气依赖(MVDC)和成功脱机两组,观察两组患者临床资料差异,采用多因素Logistic回归分析观察影响MVDC的风险因素。结果MVDC组和成功脱机组患者的长期机械通气方式和最终通气道时间差异均无统计学意义(P>0.05);MVDC组患者长期机械通气时间、重症监护病房(ICU)入住时间显著长于成功脱机组患者,生存率低于成功脱机组患者,差异均有统计学意义(P<0.05)。影响患者长期机械通气脱机的不利因素包括较高的美国脊髓损伤协会(ASIA)分级和完全性脊髓损伤(P<0.05)。MVDC组患者和成功脱机组患者的最大脊髓压缩水平、损伤节段、最大椎管占位率(MCC)差异存在统计学意义(P<0.05);两组患者T2WI信号变化节段数、形态学+椎间盘韧带复合体(DLC)评分、下颈椎损伤分类(SLIC)评分、MR表现等差异均无统计学意义(P>0.05)。多因素Logistic回归分析显示,完全性脊髓损伤、C_(3)-C_(6)节段损伤、MCC≥50.83%是影响MVDC的风险因素(P<0.05)。MCC预测MVDC的灵敏度为0.833,特异性为0.826,截断值为50.83%,曲线下面积为0.838,95%CI为0.690~0.934。结论完全性脊髓损伤、MCC、C_(3)-C_(6)损伤是颈脊髓损伤术后MVDC的重要因素,有助于预测其呼吸功能恢复结局。

Objective To investigate the prognostic factors of long-term mechanical ventilation(MV)-dependent respiratory failure after cervical spinal cord injury(CSCI).Methods 41 patients with CSCI who underwent decompression surgery in our hospital from January 2018 to September 2021 were selected as the research objects.According to whether they were successfully offline,the patients were divided into MV dependent(MVDC)and successful offline.The differences of clinical data between the two groups were observed,and the risk factors affecting mvdc were observed by multivariate logistic analysis.Results There was no significant difference in MV mode and final airway time between mvdc and patients who were successfully weaned(P>0.05).The MV time and ICU time of mvdc patients were higher than those of successful offline patients,and the survival rate was lower than that of successful offline patients(P<0.05).The adverse factors affecting MV weaning included higher Asia grade and complete spinal cord injury(P<0.05).There were significant differences in the maximum spinal cord compression level,injured segment and MCC between mvdc patients and MV patients with successful weaning(P<0.05).There was no significant difference in the number of segments of T2WI signal change,morphology+DLC score,SLIC score and Mr performance between the two groups(P>0.05).Multivariate logistic analysis showed that complete spinal cord injury,C_(3)-C_(6)segmental injury and MCC≥50.83%were the risk factors affecting mvdc(P<0.05).MCC predicted mvdc with sensitivity of 0.833,specificity of 0.826,cut-off value of 50.83%,area under the curve of 0.838 and 95%CI of 0.690-0.934.Conclusions Complete spinal cord injury,MCC and C_(3)-C_(6)injury are important factors of mvdc,which is helpful to predict the outcome of respiratory function recovery in MV patients with respiratory failure after CSCI.