高原地区急性颈髓损伤早期并发症危险因素分析
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摘要
目的分析高原地区急性颈髓损伤(ACSCI)早期并发症的种类及特点,以及致早期并发症的危险因素,为完善和改进早期救治方案及措施提供参考。方法回顾性分析青海省人民医院骨科2001年1月—2015年12月收治的ACSCI患者120例的临床资料。分析早期各种并发症的发生分布情况,并根据患者是否出现并发症将ACSCI患者分为并发症组(n=90)和无并发症组(n=30),通过单因素和多因素Logistic回归分析ACSCI患者出现早期并发症的危险因素。结果高原地区急性颈髓损伤出现早期并发症与年龄≥45岁、合并颅脑损伤、ACSCI完全损伤、颈髓损伤节段C5～7、使用糖皮质激素以及气管切开呈正相关,与本市定居时间<1年呈现负相关(P<0.05);与血清白蛋白水平、血淋巴细胞比例无相关性(P>0.05)。多因素Logistic回归分析显示,年龄≥45岁、本市定居时间<1年、颈髓损伤节段C5～7、合并颅脑损伤、气管切开及ACSCI完全损伤是高原地区ACSCI出现早期并发症的危险因素(OR/P=1.791/0.028、1.262/0.040、2.254/0.016、5.543/0.008、3.845/0.016、2.992/0.031)。结论高原地区急性颈髓损伤出现早期并发症的危险因素为年龄≥45岁、本市定居时间<1年、颈髓损伤节段C5～C7、合并颅脑损伤、气管切开及ACSCI完全损伤,损伤早期应对上述可控高危因素进行综合防治,降低早期并发症发生率。
Objective To analyze the types and characteristics of early complications of acute cervical spinal cord injury(ACSCI) at high altitude, and the risk factors of early complications, so as to provide reference for improving the early treatment plan and measures. Methods The clinical data of 120 patients with ACSCI admitted to Orthopaedics Department of Qinghai People's Hospital from January 2001 to December 2015 were retrospectively analyzed. The distribution of early complications was analyzed, and ACSCI patients were divided into complications group(n=90) and non-complications group(n=30) according to whether there were complications. The risk factors of early complications in ACSCI patients were analyzed by univariate and multivariate logistic regression. Results The early complications of acute cervical spinal cord injury in the high altitude area were positively correlated with age≥45 years,combined craniocerebral injury and ACSCI complete injury, cervical spinal cord injury segment C5-C7, glucocorticoid use and tracheotomy, and negatively correlated with city settlement time <1 year(P<0.05). There was no correlation with serum albumin level and blood lymphocyte ratio(P>0.05). Multivariate logistic regression analysis showed that the age was ≥45 years old, the city's settlement time was <1 year, and the cervical spinal cord injury segment was C5～7. Combined brain injury, tracheotomy, and complete ACSCI injury were risk factors for early complications of ACSCI in the high altitude area(OR/P=1.791/0.028, OR/P=1.262/0.040, OR/P=2.254/0.016, OR/P=5.543/0.008, OR/P=3.845/0.016, OR/P=2.992/0.031). Conclusion The risk factors of early complications of acute cervical spinal cord injury in plateau area are age(>45 years old), settlement time(<1 year), C5-C7 of cervical spinal cord injury segment, combined craniocerebral injury,tracheotomy and ACSCI complete injury. Comprehensive prevention and treatment of these controllable high-risk factors should be carried out in early stage of injury to reduce the incidence of early complications.
Objective To analyze the types and characteristics of early complications of acute cervical spinal cord injury(ACSCI) at high altitude, and the risk factors of early complications, so as to provide reference for improving the early treatment plan and measures. Methods The clinical data of 120 patients with ACSCI admitted to Orthopaedics Department of Qinghai People's Hospital from January 2001 to December 2015 were retrospectively analyzed. The distribution of early complications was analyzed, and ACSCI patients were divided into complications group(n=90) and non-complications group(n=30) according to whether there were complications. The risk factors of early complications in ACSCI patients were analyzed by univariate and multivariate logistic regression. Results The early complications of acute cervical spinal cord injury in the high altitude area were positively correlated with age≥45 years,combined craniocerebral injury and ACSCI complete injury, cervical spinal cord injury segment C5-C7, glucocorticoid use and tracheotomy, and negatively correlated with city settlement time <1 year(P<0.05). There was no correlation with serum albumin level and blood lymphocyte ratio(P>0.05). Multivariate logistic regression analysis showed that the age was ≥45 years old, the city's settlement time was <1 year, and the cervical spinal cord injury segment was C5～7. Combined brain injury, tracheotomy, and complete ACSCI injury were risk factors for early complications of ACSCI in the high altitude area(OR/P=1.791/0.028, OR/P=1.262/0.040, OR/P=2.254/0.016, OR/P=5.543/0.008, OR/P=3.845/0.016, OR/P=2.992/0.031). Conclusion The risk factors of early complications of acute cervical spinal cord injury in plateau area are age(>45 years old), settlement time(<1 year), C5-C7 of cervical spinal cord injury segment, combined craniocerebral injury,tracheotomy and ACSCI complete injury. Comprehensive prevention and treatment of these controllable high-risk factors should be carried out in early stage of injury to reduce the incidence of early complications.
引文
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[8] Minic Z,Wilson S,Liu F,et al.Nanoconjugate-bound adenosine A1 receptor antagonist enhances recovery of breathing following acute cervical spinal cord injury [J].Experimental Neurology,2017,292(6):56-62.DOI:10.1016/j.expneurol.2017.02.013.
[9] 冯程程,申才良,宋旆文,等.急性颈脊髓损伤继发低钠血症危险因素分析[J].安徽医科大学学报,2017,52(4):558-561.DOI:10.19405/j.cnki.issn1000-1492.2017.04.021.
[10] 张苗,邓小玲.颈脊髓损伤患者气管切开后呼吸道管理的研究进展[J].广东医学,2018,39(20):140-142.DOI:10.13820/j.cnki.gdyx.20181107.010.
[11] 王严,田野,滕海军,等.颈髓损伤后气管切开危险因素的Meta分析[J].中国脊柱脊髓杂志,2018,255(6):30-42.DOI:10.3969/j.issn.1004-406X.2018.06.04.
[12] Macklin R,Bae J,Orell M,et al.Time-Dependent Discrepancies between Assessments of Sensory Function after Incomplete Cervical Spinal Cord Injury[J].J Neurotrauma,2017,34(9):1778-1786.DOI:10.1089/neu.2016.4433.
[13] Zholudeva LV,Karliner J,Dougherty KJ,et al.Anatomical recruitment of spinal V2a interneurons into phrenic motor circuitry after high cervical spinal cord injury[J].Journal of Neurotrauma,2017,34(21):3058-3065.DOI:10.1089/neu.2017.5045.
[14] Hormigo KM,Zholudeva LV,Spruance VM,et al.Enhancing neural activity to drive respiratory plasticity following cervical spinal cord injury [J].Experimental Neurology,2017,287(Pt 2):276-287.DOI:10.1016/j.expneurol.2016.08.018.
[15] Richarddenis A,Erhmann Feldman D,Thompson C,et al.The impact of acute management on the occurrence of medical complications during the specialized spinal cord injury acute hospitalization following motor-complete cervical spinal cord injury[J].Journal of Spinal Cord Medicine,2018,41(4):388-396.DOI:10.1080/10790268.2017.1350331.
[16] Jiang H,Wang J,Xu B,et al.A model of acute central cervical spinal cord injury syndrome combined with chronic injury in goats[J].European Spine Journal,2017,26(1):56-63.DOI:10.1007/s00586-016-4573-6.
[17] Zakrasek EC,Nielson JL,Kosarchuk JJ,et al.Pulmonary Outcomes Following Specialized Respiratory Management for Acute Cervical Spinal Cord Injury:A Retrospective Analysis[J].Spinal Cord,2017,55(6):559-565.DOI:10.1038/sc.2017.10.
[18] Dalkilic T,Fallah N,Noonan VK,et al.Predicting injury severity and neurologic recovery after acute cervical spinal cord injury:a comparison of cerebrospinal fluid and magnetic resonance imaging biomarkers[J].Journal of Neurotrauma,2017,35(3):435-445.DOI:10.1089/neu.2017.5357.
[19] Park JH,Kim JH,Roh SW,et al.Prognostic factor analysis after surgical decompression and stabilization for cervical spinal-cord injury[J].British Journal of Neurosurgery,2017,31(2):194-198.DOI:10.1080/02688697.2016.1247781.
[20] 马俊,官众,许勇.高压氧综合治疗高原地区急性创伤性脊髓损伤研究[J].高原医学杂志,2015,6(3):20-22.
[21] Ihalainen T,Rintakiikka I,Luoto TM,et al.Risk factors for laryngeal penetration-aspiration in patients with acute traumatic cervical spinal cord injury [J].Spine Journal,2017,17(12):1956-1957.DOI:10.1016/j.spinee.2017.06.033.
[22] Wang YL,Qi YN,Wang W,et al.Effects of decompression joint Governor Vessel electro-acupuncture on rats with acute upper cervical spinal cord injury[J].Neural Regeneration Research,2018,13(7):1241-1246.DOI:10.4103/1673-5374.235062.
[23] Johansson K,Seiger A,Forsén M,et al.Assessment of voice,speech and communication changes associated with cervical spinal cord injury[J].International Journal of Language & Communication Disorders,2018,53(4) :761-775.DOI:10.1111/1460-6984.12380.
[2] Kim SW,Park CJ,Kim K,et al.Cardiac arrest attributable to dysfunction of the autonomic nervous system after traumatic cervical spinal cord injury [J].Chinese Journal of Traumatology,2017,20(2):118-121.DOI:10.1016/j.cjtee.2016.11.004.
[3] 李强,朱曦,么改琦.急性颈脊髓损伤患者气管切开时机的临床研究[J].中国微创外科杂志,2017,17(2):159-162.DOI:10.3969/j.issn.1009-6604.2017.02.015.
[4] 孙晴,鲍剑峰,安玉兰,等.高压氧及骨科综合治疗高原地区创伤性不完全脊髓损伤:开放性随机对照临床试验[J].中国组织工程研究,2017,21(20):3269-3274.DOI:10.3969/j.issn.2095-4344.2017.20.024.
[5] 郑峰,许喆,张富财.高海拔地区急性颈髓损伤早期并发症多因素分析及治疗策略研究[J].中国现代医学杂志,2017,27(24):62-65.DOI:10.3969/j.issn.1005-8982.2017.24.013.
[6] 中国康复医学会脊柱脊髓专业委员会.新鲜下颈段脊柱脊髓损伤评估与治疗的专家共识[J].中国脊柱脊髓杂志,2015,25(4):378-384.DOI:10.3969/j.issn.1004-406X.2015.04.18.
[7] Shanmuganathan K,Zhuo J,Chen HH,et al.Diffusion Tensor Imaging Parameter Obtained During Acute Blunt Cervical Spinal Cord Injury in Predicting Long Term Outcome [J].Journal of Neurotrauma,2017,34(21):2964-2971.DOI:10.1089/neu.2016.4901.
[8] Minic Z,Wilson S,Liu F,et al.Nanoconjugate-bound adenosine A1 receptor antagonist enhances recovery of breathing following acute cervical spinal cord injury [J].Experimental Neurology,2017,292(6):56-62.DOI:10.1016/j.expneurol.2017.02.013.
[9] 冯程程,申才良,宋旆文,等.急性颈脊髓损伤继发低钠血症危险因素分析[J].安徽医科大学学报,2017,52(4):558-561.DOI:10.19405/j.cnki.issn1000-1492.2017.04.021.
[10] 张苗,邓小玲.颈脊髓损伤患者气管切开后呼吸道管理的研究进展[J].广东医学,2018,39(20):140-142.DOI:10.13820/j.cnki.gdyx.20181107.010.
[11] 王严,田野,滕海军,等.颈髓损伤后气管切开危险因素的Meta分析[J].中国脊柱脊髓杂志,2018,255(6):30-42.DOI:10.3969/j.issn.1004-406X.2018.06.04.
[12] Macklin R,Bae J,Orell M,et al.Time-Dependent Discrepancies between Assessments of Sensory Function after Incomplete Cervical Spinal Cord Injury[J].J Neurotrauma,2017,34(9):1778-1786.DOI:10.1089/neu.2016.4433.
[13] Zholudeva LV,Karliner J,Dougherty KJ,et al.Anatomical recruitment of spinal V2a interneurons into phrenic motor circuitry after high cervical spinal cord injury[J].Journal of Neurotrauma,2017,34(21):3058-3065.DOI:10.1089/neu.2017.5045.
[14] Hormigo KM,Zholudeva LV,Spruance VM,et al.Enhancing neural activity to drive respiratory plasticity following cervical spinal cord injury [J].Experimental Neurology,2017,287(Pt 2):276-287.DOI:10.1016/j.expneurol.2016.08.018.
[15] Richarddenis A,Erhmann Feldman D,Thompson C,et al.The impact of acute management on the occurrence of medical complications during the specialized spinal cord injury acute hospitalization following motor-complete cervical spinal cord injury[J].Journal of Spinal Cord Medicine,2018,41(4):388-396.DOI:10.1080/10790268.2017.1350331.
[16] Jiang H,Wang J,Xu B,et al.A model of acute central cervical spinal cord injury syndrome combined with chronic injury in goats[J].European Spine Journal,2017,26(1):56-63.DOI:10.1007/s00586-016-4573-6.
[17] Zakrasek EC,Nielson JL,Kosarchuk JJ,et al.Pulmonary Outcomes Following Specialized Respiratory Management for Acute Cervical Spinal Cord Injury:A Retrospective Analysis[J].Spinal Cord,2017,55(6):559-565.DOI:10.1038/sc.2017.10.
[18] Dalkilic T,Fallah N,Noonan VK,et al.Predicting injury severity and neurologic recovery after acute cervical spinal cord injury:a comparison of cerebrospinal fluid and magnetic resonance imaging biomarkers[J].Journal of Neurotrauma,2017,35(3):435-445.DOI:10.1089/neu.2017.5357.
[19] Park JH,Kim JH,Roh SW,et al.Prognostic factor analysis after surgical decompression and stabilization for cervical spinal-cord injury[J].British Journal of Neurosurgery,2017,31(2):194-198.DOI:10.1080/02688697.2016.1247781.
[20] 马俊,官众,许勇.高压氧综合治疗高原地区急性创伤性脊髓损伤研究[J].高原医学杂志,2015,6(3):20-22.
[21] Ihalainen T,Rintakiikka I,Luoto TM,et al.Risk factors for laryngeal penetration-aspiration in patients with acute traumatic cervical spinal cord injury [J].Spine Journal,2017,17(12):1956-1957.DOI:10.1016/j.spinee.2017.06.033.
[22] Wang YL,Qi YN,Wang W,et al.Effects of decompression joint Governor Vessel electro-acupuncture on rats with acute upper cervical spinal cord injury[J].Neural Regeneration Research,2018,13(7):1241-1246.DOI:10.4103/1673-5374.235062.
[23] Johansson K,Seiger A,Forsén M,et al.Assessment of voice,speech and communication changes associated with cervical spinal cord injury[J].International Journal of Language & Communication Disorders,2018,53(4) :761-775.DOI:10.1111/1460-6984.12380.
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