急性重度颈脊髓损伤患者早期死亡影响因素的初步分析

目的探讨导致急性重度颈脊髓损伤患者早期死亡的影响因素。方法回顾性分析2003年1月-2007年12月78例急性重度颈脊髓损伤（ASIA A级和ASIA B级）的临床资料。按照患者是否于受伤后30天内死亡分为早期死亡组和早期存活组。分析患者年龄、损伤节段、损伤至入院时间、减压内固定手术、损伤至手术时间、神经源性休克、中枢性高热、低钠血症、血白蛋白、血淋巴细胞百分比、气管切开、肺部感染12项指标。结果死亡组高损伤节段（C1-C4）患者比例（8/9）高于存活组（49/69）（χ^2=18.086,P=0.000）,死亡组受伤至手术时间（1-12 d,中位数2 d）少于存活组（1-39 d,中位数3 d）（Z=-2.664,P=0.008）,死亡组出现神经源性休克比例（4/9）高于存活组（6/69）（χ^2=12.392,P=0.000）,死亡组出现低钠血症比例（4/9）高于存活组（19/69）（χ^2=4.526,P=0.033）,死亡组入院时血淋巴细胞百分比（11.84±5.80）%低于存活组（19.17±16.64）%（t=-4.006,P=0.000）,死亡组气管切开患者比例（7/9）高于存活组（10/69）（χ^2=29.749,P=0.000）,死亡组并发肺部感染患者比例（8/9）高于存活组（15/69）（χ^2=17.266,P=0.000）。结论影响急性重度颈脊髓损伤患者早期死亡的因素是多方面的,患者损伤节段高（C1-C4）、并发神经源性休克、肺部感染、行气管切开术可能是导致患者早期死亡的影响因素。

Primary Study of the Factors Causing Early Death in Patients with Acute Severe Cervical Spinal Cord Injury

Objective To study the causes of early death of patients with acute severe cervical spinal cord injury. Methods A retrospective analysis was done on 78 cases of acute severe cervical spinal cord injury, who were treated in our hospital between January 2003 and December 2007. The patients were divided into death group and survival group （ survived more than 30 days after the injury）. The clinical data including age, level of spinal cord injury, time of injury and admission, surgical treatment, duration between injury and surgery, neurogenic shock, central hyperthermia, hyponatremia, serum level of albumin, percentage of lymphocytes in serum, tracheotomy, and pulmonary infection, were recorded and analyzed. Results The proportion of high-level spinal cord injures （C1 - C4 ） in death group （8/9） was significantly higher than that in the survival group （49/69, χ^2 = 18. 086, P = 0. 000）. Whereas the duration between injury and surgery in the death group was significantly shorter than that in the survival group （1-12 d, median2 dvs 1-39 d, median3 d; Z= -2.664, P=0.008） . In the death group, 4 of the 9 patients hadneurogenic shock, and 4 developed hyponatremia, which were significantly more than those＇in the survival group （6/69, χ^2 = 12. 392, P = 0. 000 ; 19/69, χ^2 = 4. 526, P = 0. 033）. The percentage of peripheral lymphocyte on admission was （ 11.84± 5.80） % in the death group, which was significantly lower than that of the survival group （ 19.17 ±16.64） % （ t = - 4. 006, P = 0. 000）. In the death group, 7 patients received traeheotomy, and 8 patients showed pulmonary infection, the proportions were significantly higher than those in the survival group （10/69,χ^2 =29.749, P=0.000; and 15/69,χ^2 =17.266, P=0.000）. Conclusions Several factors, including high-level injury （C1 -C4 ）, neurogenic shock, pulmonary shock, and tracheotomy, may cause the death of patients with acute severe cervical spinal cord injury in an early stage.