急性创伤性脊髓损伤患者死亡原因分析

目的 分析创伤性脊髓损伤患者早期死亡原因，提出可预测患者死亡的临床指标。方法 对14例急性创伤性脊髓损伤患者的病例进行回顾性分析。结果 在426例急性创伤性脊髓损伤患者中，伤后4个月内有14例死亡，死亡原因包括气管过度刺激致心跳骤停，外科手术致病情恶化，肺炎，多器官衰竭，痰液堵塞及食物误吸致急性呼吸道梗阻等。结论 在本组病例中，创伤性脊髓损伤后4个月内死亡内为3．3％，主要原因是对气管过度刺激心跳呼吸骤停、外科手术致病情恶化和肺炎。颈5及以上3脊髓损伤或上肢肌力指数6分以下，痰多，咳嗽排痰无力，低血氧分压持续或进行性下降，出现神经恶化等可作为预测死亡的临床指标。

Death causes of patients with acute traumatic spinal cord injury

ObjectiveTo analysis the death causes of patients with acute traumatic spinal cord injury(ATSCI) during the initial four months, and determine the clinical predictors of mortality. MethodsMultiple factors that could contribute to mortality were evaluated in the retrospective study. Results3.3% of ATSCI patients died during the initial four months. The death causes were multiple factors inculding arrest of heart and respiration resulting from excessive stimulus to trachea and bronchus, interventions of surgical procedures, pneumonia, multiple organ failure, jam of sputum, and inhalation of food, etc. ConclusionsThe leading causes were the arrest of heart and respiration resulting from excessive stimulus to trachea and bronchus, interventions of surgical procedures and pneumonia. The predictors of mortality include nurological level at C 5 and above, motor index of upper extremities less than 6, copious sputum, disability of cough, low blood oxygen pressure especially with progressive decrease, and neurological deterioration, etc.