颈髓损伤后气管切开相关因素分析

目的 探讨脊髓损伤后气管切开的危险及预测因素。方法 回顾性分析10年来收治的颈髓损伤患者l064例，按美国脊髓损伤协会（ASIA）神经功能评价标准分为4级，其中A级243例，B级327例，C级306例，D级188例。除外头外伤、气管损伤和来院时已行切开患者7例，共106例患者急性期需要气管切开。评价损伤节段、年龄、吸烟史、既往疾病（糖尿病、高血压、冠心病等）、合并胸部或肺损伤等因素在气管切开的决定作用。结果 本组气管切开率最高为A级患者（35．0％，85／243）；不完全脊髓损伤（B、C和D级）气管切开率只有2．6％（21／814）。A级颈髓损伤中，C3节段损伤3例均需气管切开；C4-5节段损伤患者只占全组的43、2％（105／243），气管切开的患者却占74％（63／85）。脊髓损伤后需气管切开的可能性自C5以下逐渐减少，除了C3水平，C4水平脊髓损伤气管切开的概率最高，与其他节段比较，差异有统计学意义（P〈0．01），而C8节段的脊髓损伤则不需要气管切开。C5-7节段需要气管切开的患者年龄通常〉45岁、患有肺部疾患或者同时合并其他疾病。完全性脊髓损伤中行手术治疗97例，术后无患者需要气管切开，无切口感染发生。结论 完全性、高节段脊髓损伤的患者具有较高的气管切开率。既往肺部疾病、年龄〉45岁是气管切开的危险因素。气管切开不会增加前路手术的感染机会。

Analysis of related factors for tracheotomy after cervical spinal injuries

Objective To investigate the risk and prediction factors for tracheotomy after cervical spinal injuries. Methods A retrospective analysis was done on 1 064 cases suffering from cervical spinal injuries, of which, according to nerve function evaluation criteria of American Spinal Injury Association (ASIA), there were 243 cases at Grade A,327 at Grade B, 306 at Grade C and 188 at Grade D. Except for seven cases with brain injuries, trachea injuries, with a tracheotomy before hospitalization, a total of 106 cases needed tracheotomy during their hospitalization. The following factors were evaluated to predict the possible causes for tracheotomy: segment of injury, ages, smoking history, past diseases (such as diabetes mellitus, hypertension and coronary heart disease) and complicated chest or lung injuries. Results The highest rate of tracheotomy for cervical spinal injury at Grade A was 35.0% (85/243), while the rate of tracheotomy for incomplete injury at Grades B, C and D was only 2.6% (21/814). Of cervical spinal injury at Grade A, all C_3 segment injuries needed tracheotomy. Of all, the percentage for C_4 and C_5 segment injuries accounted for 43.2% (105/243),of which the percentage for tracheotomy was 74% (63/85). The possibility of tracheotomy decreased gradually from below C_5. Besides C_3 segment injuries, C_4 segment injuries had the highest possibility of tracheotomy, with statistical difference compared with other segments (P<0.01). C_8 segment injuries were free from tracheotomy. The cases with C_5-7 segment injuries that needed tracheotomy were usually over 45 years old, with past lung diseases or combined with other diseases. Ninety-seven cases with complete spinal cord injuries treated with surgically did not need postoperative tracheotomy, with no infection occurred. Conclusions Complete and more proximal cervical spinal injuries resulted in higher rate for tracheotomy, for which the past lung disease and age over 45 years are risk factors. The tracheotomy will not add the possibility of incision infection during anterior operation for cervical injuries.