颈髓损伤气管切开影响因素分析

[目的]探讨颈髓损伤患者气管切开的发生率和危险因素。[方法]收集整理1185例颈髓损伤患者的临床资料，统计气管切开率，通过Logistic回归分析评价年龄、性别、工作性质、受伤原因、颈髓损伤程度、颈髓损伤节段、治疗期间营养状态等因素对于患者气管切开率的影响。统计相关因素各分项下的气管切开率。[结果]99例患者被实施气管切开，气管切开率8．35％。年龄、颈髓损伤程度、颈髓损伤节段、受伤原因等因素与气管切开率相关，其他一些因素与气管切开率无显著相关性。随年龄的增长，颈髓损伤患者气管切开率逐渐增加，〈20岁的患者，无1例实施气管切开，〉60岁的患者气管切开率高达38．7％；随颈髓损伤程度的加重和节段的升高，气管切开率不断增加，ASIA分级D级颈髓损伤患者气管切开率为0．5％，而完全性颈髓损伤患者气管切开率高达19．1％；C7～C4节段的颈髓完全性损伤气管切开率分别为4．3％，22．3％，21．6％和32．7％，而c3和c3以上节段的完全性损伤患者，大部分在实施气管切开之前即发生死亡，故气管切开率并不高。高处坠落所致颈髓损伤患者较其他患者有更高的气管切开率。[结论]颈髓严重损伤、颈髓高位损伤和高龄是颈髓损伤患者气管切开的主要危险因素。高位的（c3和c3以上）颈髓完全性损伤患者应尽早实施气管切开。

Influencing factors for tracheotomy after cervical spinal Cord injury

[Objective] To investigate risk factors and the incidence rate of tracheotomy after cervical spinal cord injuries.[Method]A retrospective analysis was done on 1185 cases suffering from cervical spinal cord injuries statistically.The following correlation factors: ages,gender,type of job,reason of injuries,degree of spinal cord injuries,segment of spinal cord injures,nutritional status during therapy were evaluated by Binary Logistic Regression to discover tile influencing factors for tracheotomy.[Result]Totally 99 cases were undergone tracheotomy(male 87 and female 14).The rate of tracheotomy was 8.35%,Ages,degree of spinal cord injuries,segment of spinal cold injuries,reason of injuries had influence to rate of tracheotomy.The other factors were not correlation to tracheotomy.With increasing of age,the rate of tracheotomy was gradually increased.Nobody was undergone tracheotomy in patients who was younger than 20 years old,and the rate of tracheotomy was 38.7% in patients who was older than 60 years old.With aggravating and segment going up of cervical spinal cord injuries,the rate of tracheotomy was gradually increased.The rate of tracheotomy for cervical spinal cord injury at Grade D was 0.5%,While the rate of tracheotomy for cervical spinal cord complete injury was 19.1%.Tile rate of tracheotomy for cervical spinal cord complete injury was 4.3,22.3,21.6 and 32.7% from C7 to C4,while the rate wasn't high in C3 and C2,because most of these patients had died before they was undergone tracheotomy.The rate of tracheotomy was higher in patients who got injuries from fall than other.[Conclusion]Elder,cervical spinal cord severe injuries,high cervical spinal cord injuries was risk factors for tracheotomy.The patients who got cervical spinal cord complete injuries in C3 or higher than C3 need tracheotomy as early as possible.