创伤性颈髓损伤早期并发呼吸衰竭风险及影响因素研究

目的 探讨创伤性颈髓损伤(TCSCI)早期并发呼吸衰竭的风险及影响因素，为评估、改善TCSCI患者预后提供可参考依据。 方法 采用回顾性研究方法，选择2011年6月—2015年6月期间丽水市中心医院收治的212例TCSCI患者作为研究对象。收集患者相关临床资料，根据是否并发呼吸衰竭进行分组，41例并发呼吸衰竭患者作为研究组，171例无呼吸衰竭患者作为对照组。单因素分析研究组间性别、年龄、受伤原因、损伤平面、是否伴有骨折脱位、ASIA分级情况差异，并纳入Logistic回归多因素分析研究并发呼吸衰竭的危险因素。 结果 2组是否伴有骨折脱位(χ2=7.964，P=0.005)、损伤平面(χ2=15.826，P＜0.001)、受伤原因(χ2=4.3047，P=0.014)、ASIA (χ2=51.947，P＜0.001)差异有统计学意义，性别(χ2=0.040，P=0.624)、年龄(χ2=1.517，P=0.468)组间差异无统计学意义，Logistic回归显示，是否伴有骨折脱位(OR=6.120，95%CI:1.574～9.644)、损伤平面(OR=2.215，95%CI:1.369～3.454)、ASIA分级(OR=1.925，95%CI:1.122～2.774)是独立的影响因素。 结论 伴有骨折脱位、损伤平面C4以上、ASIA分级高可能是TCSCI早期并发呼吸衰竭的危险因素，应采取针对性的预防措施降低并发呼吸衰竭风险、改善患者预后。 

Risk of early respiratory failure in traumatic cervical spinal cord injury patients and influencing factors

Objective To study the risk of early respiratory failure complication in patients with traumatic cervical spinal cord injury(TCSCI) and related influencing factors,and provide basis for evaluation and promotion of prognosis of patients. Methods The study was a reviewing trial.Total 212 TCSCI patients in our hospital from June,2011 to June,2015 were enrolled into this study.The clinical data were collected,and patients were grouped based on respiratory failure.Forty-one TCSCI patients with early respiratory failure were selected as study group,and 171 patients without respiratory failure as control group,and prognosis situation of patients were compared between groups.The influencing factors on early respiratory failure were analyzed by single factor analysis and Logistic aggression analysis. Results There was difference between the patients with or without fracture dislocation(χ2=7.964,P=0.005),skeletal level(χ2=15.826,P<0.001),injuring reasons(χ2=4.305,P=0.014),ASIA classification(χ2=51.947,P<0.001).Logistic aggression revealed that whether accompanied by fracture dislocation(OR=6.120,95%CI:1.574-9.644),skeletal level(OR=2.215,95%CI:1.369-3.454),ASIA classification(OR=1.925,95%CI:1.122-2.774)were impact factors of early respiratory failure complication of TCSCI. Conclusion The fracture dislocation,skeletal level above C4,high ASIA classification could be risk factors of early respiratory failure complication,specific precautionary measures should be reinforced to decrease risk of respiratory failure and improve prognosis.