CAJ | 학술논문

【目的】分析急性颈髓损伤致气管切开的危险因素，并探讨预见性气管切开对急性颈髓损伤患者脱离呼吸机时间、二重感染率的影响。【方法】①回顾性分析中国医科大学附属盛京医院2007年7月至2014年10月收治的共682例急性颈髓损伤的患者的临床资料。将其分为气管切开组及非气管切开组。通过χ2检验、t检验及Logistic回归分析评估年龄、性别、工作性质、最高损伤节段、ASIA分级、是否合并胸部外伤、受伤原因、受伤至入院时间等因素对气管切开的影响作用。②在以上研究基础上将气管切开患者分为早期干预组及非早期干预组。统计两组患者脱离呼吸机时间、二重感染的人数，比较两者的统计学差异。【结果】①682例患者中，64例行气管切开术，占9．4％。其中年龄、最高损伤节段、ASIA分级是急性期颈髓损伤的独立危险因素。②早期干预组患者23例，其中2例死亡、5例失访，其余患者脱机时间（17．9±3．8） d ，二重感染率31．3％。非早期干预组41例，其中6例死亡、9例失访，其余患者脱机时间（22．0±4．6）d ，二重感染率65．4％。在脱离呼吸机时间及二重感染率的比较上有统计学意义。【结论】气管切开有利有弊，如果患者年龄大、损伤节段高、损伤程度重，早期气管切开还是利大于弊，值得提倡。
【목적】분석급성경수손상치기관절개적위험인소，병탐토예견성기관절개대급성경수손상환자탈리호흡궤시간、이중감염솔적영향。【방법】①회고성분석중국의과대학부속성경의원2007년7월지2014년10월수치적공682례급성경수손상적환자적림상자료。장기분위기관절개조급비기관절개조。통과χ2검험、t검험급Logistic회귀분석평고년령、성별、공작성질、최고손상절단、ASIA분급、시부합병흉부외상、수상원인、수상지입원시간등인소대기관절개적영향작용。②재이상연구기출상장기관절개환자분위조기간예조급비조기간예조。통계량조환자탈리호흡궤시간、이중감염적인수，비교량자적통계학차이。【결과】①682례환자중，64례행기관절개술，점9．4％。기중년령、최고손상절단、ASIA분급시급성기경수손상적독립위험인소。②조기간예조환자23례，기중2례사망、5례실방，기여환자탈궤시간（17．9±3．8） d ，이중감염솔31．3％。비조기간예조41례，기중6례사망、9례실방，기여환자탈궤시간（22．0±4．6）d ，이중감염솔65．4％。재탈리호흡궤시간급이중감염솔적비교상유통계학의의。【결론】기관절개유리유폐，여과환자년령대、손상절단고、손상정도중，조기기관절개환시리대우폐，치득제창。
[Objective] To analyze the risk factors of predictability tracheotomy for acute spinal cord injury .[Methods]From July 2007 to October 2014 ,retrospective analysis was conducted for 682 cases of acute cervical spi‐nal cord injury .They were divided into tracheotomy and non‐tracheostomy groups .The SPSS software ,chi‐square test ,t test and Logistic regression analysis were used to evaluate the effects of age ,gender ,profession ,maximum injury segment ,ASIA grade ,associated chest trauma ,cause of injury and injury to hospitalization time .And the tracheotomy group was further assigned into early‐intervention and non‐early‐intervention sub‐groups .The parame‐ters of ventilator time and number of superinfection were compared .[Results]Among them ,there were 64 (9 .4% ) cases of tracheotomy .Age ,maximum injury segment and ASIA grade were independent risk factors for acute cervi‐cal spinal cord injury .Early intervention sub‐group ( n=23) included mortality ( n=2) and loss ( n=5) .And for the remainder ,offline time was (17 .9 ± 3 .8) days and superinfection rate 31 .3% .And early non‐intervention sub‐group ( n =41) included mortality ( n=6) and loss ( n=9) .And for the reminder ,offline time (22 .0 ± 4 .6) days and superinfection rate of 65 .4% .There were statistically significant differences in ventilator time and superinfec‐tion rate .[Conclusion] Tracheotomy has both advantages and disadvantages .Early tracheotomy is recommended for advanced age ,high segment and severe injury .