急性颈脊髓损伤患者气管切开影响因素研究

目的探讨影响颈脊髓损伤患者气管切开的相关影响因素。方法回顾性分析512例颈脊髓损伤患者的临床资料。按来院后是否行气管切开手术将患者分为气管切开组和非气管切开组。将15项指标作为相关影响因素的分析对象，行单因素分析，有统计学意义的指标再进行Stepwise Logistic回归分析。结果512例患者中，46例患者行气管切开（气切组），466例未行气管切开（非气切组）。两组年龄（43．0±13．1）岁，（38．1±13．8）岁]、颈脊髓损伤程度（ASIA分级）（1．61±0．91，3．34±1．50）、损伤至入院的时间（1．85±1．09）d，（3．24±4．28）d]、损伤至手术时间（3．34±4．60）d，（11．47±16．91）d]、低钠血症发生率（53．3％，7．1％）、神经源性休克发生率（31．4％，2．4％）、中枢性高热发生率（31．4％，18．6％）、血白细胞数量（11．1±3．5）×10^9／L，（9．1±4．0）×10^9／L]、血中性粒细胞（0．84±0．06，0．77±0．09）、血淋巴细胞（0．12±0．06，0．20±0．12）、血浆白蛋白（36．93±6．18）g／L，（40．96±4．55）g／L]、肺部感染率（35．2％，4．2％）12项指标比较均有显著性差异（P〈0．05）。患者年龄、颈脊髓损伤程度（ASIA分级）、并发肺部感染为急性颈脊髓损伤患者气管切开的3个独立相关影响因素。结论影响急性颈脊髓损伤患者气管切开的因素是多方面的，患者年龄大、颈脊髓损伤程度重（ASIA分级）、并发肺部感染是3个相姜独寺影响因素．

The study of influencing factors for the patients of acute cervical spinal cord injury with tracheostomy

Objective To study the influencing factors for the patients of acute cervical spinal cord injury with tracheostomy. Method A retrospective analysis was done on 512 patients with acute cervical spinal cord injury in our hospital. The patients were divided into two groups according to whether or not tracheostomy in hospital. Fifteen variables were analyzed by t test for continuous variables andχ^2 test for discrete variables. The variables with significance （ P 〈 0.05 ） were then analyzed with stepwise logistic regression. Results The tracheostomy was done in 46 patients,and it was not done in the others. Twelve continuous variables, including the age of the patients （P = 0. 021 ）, degree of spinal cord injuries （ ASIA grade） （ P = 0. 000 ）, timing of admission （ P = 0. 000 ）, timing of surgical intervention （ P = 0. 000 ）, hyponatremia （ P = 0. 000 ） , presence of neurogenic shock （ P = 0. 000 ）, central hyperpyrexia （ P = 0. 000 ）, peripheral Leukocytes （ P = 0.001 ）, peripheral neutrophilic granulocyte （ P = 0. 000 ）, peripheral lymphocyte （ P = 0. 000 ）, blood plasma albumin （ P = 0. 000） （ the four laboratory examination indexes above on the first day of admission） ,pulmonary infection（ P = 0. 000） had significant difference between two groups. The stepwise logistic regression analysis for the 12 variables demonstrated that the age,the degree of spinal cord injuries（ ASIA grade）and pulmonary infection were the independent risk factors. Conclusion The relative risks for the patients of acute cervical spinal cord injury with tracheostomy is multiple, and the age, degree of spinal cord injuries （ASIA grade）and pulmonary infection are the independent risk factors .