摘要
目的探讨颈脊髓损伤(CSCI)后气管切开的危险因素及关键肌肌力对指导床旁行气管切开的预测作用。方法采用回顾性病例对照研究分析2009年1月—2013年12月陆军军医大学新桥医院收治的294例CSCI患者临床资料,其中男243例,女51例;年龄10~82岁[(48.9±14.7)岁]。52例行气管切开(气管切开组)及242例未行气管切开(气管未切开组)。收集患者基本资料,包括性别、年龄、吸烟史、致伤原因;损伤评估指标,包括损伤节段、伴发伤、颈椎脱位、美国脊髓损伤协会(ASIA)分级;关键肌肌力,包括耸肩(斜方肌)、肩外展(三角肌)、屈肘(肱二头肌)。比较两组各项指标的差异,并通过单因素分析和二元逻辑回归分析筛选影响气管切开的具有统计学意义的因素。最终,通过多元逻辑回归分析确定行气管切开的独立危险因素和可预测行气管切开的上肢关键肌肌力。结果两组在吸烟史、高处坠落伤、伴颈椎脱位、C2~C4初始ASIA分级A级、耸肩肌力、肩外展肌力及屈肘肌力方面,差异有统计学意义(P<0.05)。通过二元逻辑回归分析,初步得出有吸烟史、交通伤、高处坠落伤、伴颈椎脱位、C2~C4ASIA分级A级、C5~C8ASIA分级A级有统计学意义(P<0.05)。再将其纳入多元逻辑回归分析显示,有吸烟史(OR=2.27)、伴颈椎脱位(OR=3.70)及C2~C4 ASIA分级A级(OR=8.31)与CSCI气管切开显著相关(P<0.05)。将耸肩肌力3级及以下、肩外展肌力2级及以下及屈肘肌力2级及以下,分别与有吸烟史、伴颈椎脱位及C2~C4 ASIA分级A级三个危险因素共同行多元逻辑回归分析,得出耸肩肌力3级及以下和肩外展肌力2级及以下与CSCI患者行气管切开显著相关(P<0.05)。结论C4以上ASIA分级A级、伴颈椎脱位、吸烟史是CSCI行气管切开的独立危险因素。耸肩肌力3级及以下和肩外展肌力2级及以下对CSCI需行气管切开具有床旁预测作用。
Objective To investigate the risk factors of tracheotomy after cervical spinal cord injury(CSCI)and the predictive role of key muscle strength in guiding bedside tracheotomy.Methods A retrospective case-control study was used to analyze the clinical data of 294 patients with CSCI admitted to Xinqiao Hospital of Army Medical University from January 2009 to December 2013,including 243 males and 51 females,with the age range of 10-82 years[(48.9±14.7)years].A total of 52 patients treated with tracheotomy(tracheotomy group),while 242 patients did receive tracheotomy(non-tracheotomy group).The indices were collected and compared between groups,including demographic data(gender,age,smoking history,cause of injury),injury severity data[level of injury,combined injury,cervical dislocation,American Spinal Cord Injury Association(ASIA)classification],and key muscle function strength[shrug(trapezius),shoulder abduction(deltoid)and elbow flexion(biceps)].The risk factors affecting the tracheotomy were identified by the univariate logistic regression analysis and binary logistic regression analysis.The independent risk factor for tracheostomy and predictive role of key muscle strength was determined by the multiple logistic regression analysis.Results Smoking history,falling injury,cervical dislocation,C2-C4 AISA scale A,shoulder-shrugging muscle strength,shoulder abduction muscle strength and elbow flexion strength were significantly different between groups(P<0.05).Through the binary logistic regression analysis,it was preliminarily concluded that smoking history,traffic injury,falling injury,cervical dislocation,C2-C4 AISA scale A,and C5-C8 AISA scale A were statistically significant between groups(P<0.05).The multiple logistic regression analysis showed smoking history(OR=2.27),cervical dislocation(OR=3.70)and C2-C4 AISA scale A(OR=8.31)were significantly related to tracheostomy(P<0.05).The multiple logistic regression analysis showed shoulder-shrugging muscle strength grade 3 and below and shoulder abduction muscle stre
作者
孙大卫
刘科
穆智平
聂丕明
张正丰
Sun Dawei;Liu Ke;Mu Zhiping;Nie Piming;Zhang Zhengfeng(Department of Orthopedics,Xinqiao Hospital,Army Medical University,Chongqing 400037,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2020年第7期602-607,共6页
Chinese Journal of Trauma
基金
国家自然科学基金(81572210)。
关键词
脊髓损伤
气管切开术
危险因素
肌力
Spinal cord injuries
Tracheotomy
Risk factors
Muscle strength
