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

Multivariate analysis and treatment strategy of early complications of acute cervical spinal cord injury in high altitude area

摘要:

目的探究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。方法回顾性分析2011年1 月-2016 年12 月青海省人民医院骨科收治的302 例急性颈髓损伤患者的临床资料，分析患者早期并发症的分布，单因素和Logistic多因素分析高海拔地区急性颈髓损伤早期并发症的危险因素。结果302 例急性颈髓损伤患者中共241（79.80％）例存在不同类型的早期并发症，主要有便秘（75.49％）、心率减慢（47.35％）、低钠血症（45.03％）、高热（40.72％）、呼吸功能障碍（34.10％）和血压下降（30.79％）。Logistic多因素分析结果显示，西宁市定居时间<1 年、完全性脊髓损伤、脊髓损伤部位为C4及以上、合并颅脑损伤、未进行气管切开和未进行雾化吸入排痰为高海拔地区急性颈髓损伤患者发生早期并发症的危险因素（OR=1.737、3.522、3.673、2.301、1.993 和2.942，均<0.05）。结论高海拔地区急性颈髓损伤患者早期并发症发生率较高，临床上可以对西宁市定居时间<1 年、完全性脊髓损伤、脊髓损伤部位为C4及以上、合并颅脑损伤、未进行气管切开和未进行雾化吸入排痰患者加强监控，降低早期并发症的发生率。

Abstract:

Objective To explore the multivariate analysis and treatment strategy of early complications of acute cervical spinal cord injury in high altitude area. Methods The clinical data of 302 patients with acute cervical spinal cord injury were analyzed retrospectively from January 2011 to December 2016. The distribution of early complications in the patients was analyzed, and risk factors of early complications was analyzed by single factor and Logistic multivariate analysis. Results Of the 302 patients, 241 (79.80%) had different types of early complications, including constipation (75.49% ), heart rate reduction (47.35% ),hyponatremia (45.03%), high fever (40.72%), respiratory dysfunction (34.10%) and blood pressure reduction(30.79%). Logistic multivariate analysis showed that settlement time less than 1 year, complete spinal cord injury, C4 and above levels of spinal cord injury, combining with craniocerebral injury, without tracheotomy and without atomization sputum suction were risk factors of early complications of acute cervical spinal cord injury in high altitude area (OR= 1.737, 3.522, 3.673, 2.301, 1.993 and 2.942,P < 0.05). Conclusions The incidence of early complications in patients with acute cervical spinal cord injury in high altitude area ishigh. Clinical monitoring can be strengthened to the patients with settlement time less than 1 year, with complete spinal cord injury, with C4 and above levels of spinal cord injury, combining with craniocerebral injury, without tracheotomy and without atomization sputum suction to reduce the incidence of early complications.