中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2013年
5期
294-297
,共4页
冷玉鑫%聂春艳%姚智渊%朱曦
冷玉鑫%聶春豔%姚智淵%硃晞
랭옥흠%섭춘염%요지연%주희
脊髓损伤,重度%颈部%危险因素
脊髓損傷,重度%頸部%危險因素
척수손상,중도%경부%위험인소
Severe spinal cord injury%Cervical%Risk factor
目的 寻找急性重度外伤性颈脊髓损伤患者早期死亡的危险因素.方法 回顾性分析1994年1月1日至2012年10月1日本院收治的急性重度外伤性颈脊髓损伤患者的临床资料,按30 d内是否死亡分为死亡组和存活组.通过单因素分析和logistic回归分析来寻找影响患者早期死亡的危险因素.结果 1093例急性外伤性颈脊髓损伤患者中有352例重度患者纳入本研究,早期病死率为14.49％(51/352);致伤原因以车祸伤(153例)和摔伤(117例)为主；死亡原因以呼吸衰竭(16例)、多器官功能衰竭(14例)、消化道出血(11例)居多.综合单因素分析和logistic回归分析发现:高急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分[＞15分,优势比(OR=11.595,P=0.000]、高损伤节段(OR=3.519,P=0.032)、低钠血症(OR =6.316,P=0.000)、神经源性休克(OR=6.209,P=0.000)、肺部感染(OR=14.627,P=0.000)、气管切开(OR=8.983,P=0.000)等因素为重度损伤患者早期死亡的危险因素；而性别,年龄,是否手术,是否存在骨折或脱位、中枢性高热,是否使用糖皮质激素等因素对急性重度颈脊髓损伤患者是否早期死亡无确切影响.结论 反映急性重度外伤性颈脊髓损伤患者病情严重程度和并发症的相关指标对预测患者是否早期死亡的意义更大；而年龄、手术等相关因素的影响被削弱.
目的 尋找急性重度外傷性頸脊髓損傷患者早期死亡的危險因素.方法 迴顧性分析1994年1月1日至2012年10月1日本院收治的急性重度外傷性頸脊髓損傷患者的臨床資料,按30 d內是否死亡分為死亡組和存活組.通過單因素分析和logistic迴歸分析來尋找影響患者早期死亡的危險因素.結果 1093例急性外傷性頸脊髓損傷患者中有352例重度患者納入本研究,早期病死率為14.49％(51/352);緻傷原因以車禍傷(153例)和摔傷(117例)為主；死亡原因以呼吸衰竭(16例)、多器官功能衰竭(14例)、消化道齣血(11例)居多.綜閤單因素分析和logistic迴歸分析髮現:高急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分[＞15分,優勢比(OR=11.595,P=0.000]、高損傷節段(OR=3.519,P=0.032)、低鈉血癥(OR =6.316,P=0.000)、神經源性休剋(OR=6.209,P=0.000)、肺部感染(OR=14.627,P=0.000)、氣管切開(OR=8.983,P=0.000)等因素為重度損傷患者早期死亡的危險因素；而性彆,年齡,是否手術,是否存在骨摺或脫位、中樞性高熱,是否使用糖皮質激素等因素對急性重度頸脊髓損傷患者是否早期死亡無確切影響.結論 反映急性重度外傷性頸脊髓損傷患者病情嚴重程度和併髮癥的相關指標對預測患者是否早期死亡的意義更大；而年齡、手術等相關因素的影響被削弱.
목적 심조급성중도외상성경척수손상환자조기사망적위험인소.방법 회고성분석1994년1월1일지2012년10월1일본원수치적급성중도외상성경척수손상환자적림상자료,안30 d내시부사망분위사망조화존활조.통과단인소분석화logistic회귀분석래심조영향환자조기사망적위험인소.결과 1093례급성외상성경척수손상환자중유352례중도환자납입본연구,조기병사솔위14.49％(51/352);치상원인이차화상(153례)화솔상(117례)위주；사망원인이호흡쇠갈(16례)、다기관공능쇠갈(14례)、소화도출혈(11례)거다.종합단인소분석화logistic회귀분석발현:고급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분[＞15분,우세비(OR=11.595,P=0.000]、고손상절단(OR=3.519,P=0.032)、저납혈증(OR =6.316,P=0.000)、신경원성휴극(OR=6.209,P=0.000)、폐부감염(OR=14.627,P=0.000)、기관절개(OR=8.983,P=0.000)등인소위중도손상환자조기사망적위험인소；이성별,년령,시부수술,시부존재골절혹탈위、중추성고열,시부사용당피질격소등인소대급성중도경척수손상환자시부조기사망무학절영향.결론 반영급성중도외상성경척수손상환자병정엄중정도화병발증적상관지표대예측환자시부조기사망적의의경대；이년령、수술등상관인소적영향피삭약.
Objective To survey the risk factors for early death of patients with acute severe traumatic cervical spinal cord injury.Methods A retrospective analysis of data of consecutive patients with acute severe traumatic cervical spinal cord injury admitted from January 1st 1994 to October 1st 2012 were made.The patients died within 30 days or not were allocated for death group or survival group.The risk factors for early death were analyzed through univariate analysis and logistic analysis.Results Among 1093 patients with acute traumatic cervical spinal cord injury,352 patients with severe injury were included,and the early death rate was 14.49％ (51/352).The leading causes of spinal cord injury were vehicle accidents (153 cases) and falls (117 cases).The main causes of early death were respiratory failure (16 cases),multiple organ failure (MOF,14 cases) and gastrointestinal bleeding (11 cases).Combining the results of univariate and logistic analysis,it was found that high acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score [＞15,odds ratio (OR)=11.595,P=0.000],high damage level (OR=3.519,P=0.032),hyponatremia (OR=6.316,P=0.000),neurogenic shock (OR=6.209,P=0.000),pulmonary infection (OR=14.627,P=0.000) and tracheostomy (OR=8.983,P=0.000) were risk factors for early death of patients with acute severe traumatic cervical spinal cord injury,however,the impact of gender,age,surgery,fracture and dislocation,high central fever,and administration of steroids on early death of patients with acute severe traumatic cervical spinal cord injury were uncertain.Conclusion The factors reflecting disease severity and occurrence of related complications were more important in predicting the early death among patients with acute severe traumatic cervical spinal cord injury,while the influence of age,surgical manipulation etc.were minor factors.
