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目的探讨创伤性颈髓损伤(TCSCI)早期并发呼吸衰竭的风险及影响因素,为评估、改善TCSCI患者预后提供可参考依据。方法采用回顾性研究方法,选择2011年6月—2015年6月期间丽水市中心医院收治的212例TCSCI患者作为研究对象。收集患者相关临床资料,根据是否并发呼吸衰竭进行分组,41例并发呼吸衰竭患者作为研究组,171例无呼吸衰竭患者作为对照组。单因素分析研究组间性别、年龄、受伤原因、损伤平面、是否伴有骨折脱位、ASIA分级情况差异,并纳入Logistic回归多因素分析研究并发呼吸衰竭的危险因素。结果 2组是否伴有骨折脱位(χ2=7.964,P=0.005)、损伤平面(χ2=15.826,P<0.001)、受伤原因(χ2=4.3047,P=0.014)、ASIA(χ2=51.947,P<0.001)差异有统计学意义,性别(χ2=0.040,P=0.624)、年龄(χ2=1.517,P=0.468)组间差异无统计学意义,Logistic回归显示,是否伴有骨折脱位(OR=6.120,95%CI:1.574~9.644)、损伤平面(OR=2.215,95%CI:1.369~3.454)、ASIA分级(OR=1.925,95%CI:1.122~2.774)是独立的影响因素。结论伴有骨折脱位、损伤平面C4以上、ASIA分级高可能是TCSCI早期并发呼吸衰竭的危险因素,应采取针对性的预防措施降低并发呼吸衰竭风险、改善患者预后。
Objective To investigate the risk and influencing factors of early stage traumatic cervical spinal cord injury (TCSCI) complicated with respiratory failure and to provide a reference for evaluating and improving the prognosis of patients with TCSCI. Methods A retrospective study was conducted to select 212 patients with TCSCI admitted to Lishui Central Hospital from June 2011 to June 2015. The clinical data of patients were collected and divided according to whether they were complicated by respiratory failure. 41 patients with respiratory failure and 171 patients without respiratory failure were selected as the control group. Univariate analysis was used to investigate the gender, age, cause of injury, level of injury, whether there was fracture-dislocation or ASIA grade. Logistic regression multivariate analysis was used to investigate the risk factors of concurrent respiratory failure. Results There was no significant difference between the two groups (χ2 = 7.964, P = 0.005), injury plane (χ2 = 15.826, P <0.001) There was no significant difference between the two groups (χ2 = 0.040, P = 0.624) and age (χ2 = 1.517, P = 0.468). Logistic regression showed that whether there was fracture or dislocation (OR = 2.215, 95% CI: 1.369 ~ 3.454). ASIA classification (OR = 1.925, 95% CI: 1.122-2.774) was an independent influencing factor. Conclusions Complicated fractures and dislocations, injury plane C4 above, high ASIA grade may be risk factors for early TCSCI complicated with respiratory failure. Targeted preventive measures should be taken to reduce the risk of concurrent respiratory failure and improve prognosis.