急性创伤性颈髓损伤患者术前机械通气的危险因素分析

Analysis of risk factors for preoperative mechanical ventilation in patients with acute traumatic cervical spinal cord injury

目的:分析急性创伤性颈髓损伤(TCSCI)患者术前机械通气的相关危险因素。方法:将2016年11月至2018年5月期间收治的59例TCSCI患者根据术前是否给予机械辅助通气分为机械通气组(37例)和非机械通气组(22例)。最常见伤因是高处坠落(30例,50.8%),其次是交通事故(22例,37.3%),最常见的神经损伤平面是C1-C4(36例,61%)。运用美国脊髓损伤协会(ASIA)损伤程度和ASIA运动得分(AMS)评估受影响的神经系统平面和脊髓损伤的程度,使用创伤严重程度评分(ISS)来评估损伤的严重程度。运用多变量Logistic回归分析TCSCI机械通气的危险因素。并运用ROC曲线评估AMS和ISS在预测机械通气的价值。结果:单变量分析结果显示机械通气组的男性、完全损伤、存在相关损伤的比例均显著高于非机械通气组(P<0.05)。机械通气组的AMS评分显著低于无机械通气组(16.4±10.7和39.1±9.5,P<0.001),ISS评分显著高于无机械通气组(31.6±8.0和26.5±6.7,P=0.015)。多变量Logistic回归分析结果显示,AMS[OR=3.340,95%CI(1.321,6.242),P<0.001]和ISS[OR=1.120,95%CI(0.306,3.786),P<0.001]是预测需要机械通气的显著危险因素。ROC分析结果显示AMS的ROC曲线下面积显著高于ISS (0.899和0.685,P<0.05)。结论:患者入院时的AMS和ISS可以作为早期是否给予机械辅助通气的预测指标。

Objective:To analyze the risk factors associated with mechanical ventilation before surgery in patients with acute traumatic cervical spinal cord injury(TCSCI).Methods:According to whether preoperative mechanical ventilation,59 patients with TCSCI admitted to our hospital from November 2016 to May 2018 were divided into mechanical ventilation(MV)group(37 cases)and non-mechanical ventilation(non-MV)group(22 cases).Falling from height was the most common causes of injury(30 cases,50.8%),then was traffic accident(22 cases,37.3%).The most common paraplegic plane was in C1-C4(36 cases,61%).American Spinal Cord Injury Association(ASIA)injury degree and ASIA exercise score(AMS)were used to assess the extent of affected neurological plane and spinal cord injury.Trauma severity score(ISS)was used to evaluate the severity of the injury.Multivariate Logistic regression was used to analyze the risk factors for mechanical ventilation in TCSCI.ROC curves were used to assess the value of AMS and ISS in predicting mechanical ventilation.Results:Univariate analysis showed that the percentage of male,complete injury and related injuries in the MV group were significantly higher than those in the non-MV group(P<0.05).The AMS score of the MV group was significantly lower than that of the non-MV group(16.4±10.7 vs 39.1±9.5,P<0.001),and the ISS score was significantly higher than that of the non-MV group(31.6±8.0 vs 26.5±6.7,P=0.015).Multivariate Logistic regression analysis showed that AMS[OR=3.340,95%CI(1.321,6.242),P<0.001]and ISS[OR=1.120,95%CI(0.306,3.786),P<0.001]were significant risk factors on predicting the need for mechanical ventilation.The ROC analysis showed that the area under the ROC curve(AUC)of AMS was significantly higher than that of ISS(0.899 vs0.685,P<0.05).Conclusion:AMS and ISS at admission can be used as predictors of early mechanically assisted ventilation.