地震中颈椎骨折伴颈脊髓损伤和(或)肺部并发症患者救治体会

目的 分析四川大地震中颈椎骨折伴颈脊髓损伤患者肺部并发症的发生原因并总结救治体会.方法 回顾性分析泸州医学院附属医院神经外科自2008年5月12日至2008年8月6日收治的9例颈椎骨折伴颈脊髓损伤患者的临床资料.结果 颈椎骨折伴颈脊髓损伤患者均采取手术治疗,其中6例伤后5 d内发生肺部并发症,其中肺炎3例,通气障碍2例,肺水肿和血气胸1例,经积极的呼吸道管理等非手术治疗,肺部并发症都得到有效控制.结论 颈椎骨折伴颈脊髓损伤急性期(<5 d)常发生严重肺部并发症.以高位损伤(C4>以上)、合并胸部损伤、高龄、有肺部疾患史与吸烟史者更易发生,早期发现后内科治疗效果好.

Experience with the management of pulmonary complications in patients with cervical spine fractures and concurrent cervical cord injury in Wenchuan earthquake

Objective To investigate the factors associated with the occurrence of pulmonary complication in patients with cervical spine fiactures and concurrent cervical cord injury in Wenchuan earthquake. Methods A retrospective analysis was conducted among the 9 patients with cervical spine fractures and cervical cord injuries treated in our department between May 12 to August 6, 2008. Results All the patients received surgical treatment for cervical spine fractures and cervical cord injuries. Six of the patients developed pulmonary complications 5 days after the injury, including 3 patients with pneumonia, 2 with ventilation disorder, and 1 with lung edema and hemopnenmothorax. Aggressive respiratory management was administered in these patients, and the pulmonary complications were effectively controlled. Conclusion Patients with cervical spine fractures and concurrent cervical cord injury often experience severe pulmonary complications during the acute phase (<5 days), which can be more likely in patients with high level injury, chest trauma, old age, preexisting pulmonary illnesses or smoking history. Early detection of the complications results in better therapeutic effect with conservative therapy.