Wright S W, Robinson G G, Wright M B
Division of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN 37212.
Am J Emerg Med. 1992 Mar;10(2):104-9. doi: 10.1016/0735-6757(92)90039-z.
Airway management in the blunt trauma patient is complicated by the potential for causing or exacerbating an injury to the cervical cord if an unstable cervical fracture is present. The records of 987 blunt trauma patients who required emergent endotracheal intubation over a 5-year period were retrospectively reviewed to determine the incidence and type of cervical spine injury and the incidence of injury based on airway management. Sixty of the patients (6.1%) had a cervical fracture; 53 were potentially unstable injuries by radiographic criteria. Twenty patients had neurologic deficits prior to intubation. Twenty-six patients with unstable injuries were intubated orally, 25 nasally, and two by cricothyrotomy. One patient developed a neurologic deficit after nasotracheal intubation. Because of a possible selection bias in which severely injured patients were preferentially referred to this trauma center, the true incidence of cervical spine injuries may be lower than the 6.1% we found. The authors conclude that the incidence of serious cervical spine injury in a very severely injured population of blunt trauma patients is relatively low, and that commonly used methods of precautionary airway management rarely lead to neurologic deterioration.
对于钝性创伤患者，如果存在不稳定的颈椎骨折，气道管理会因有可能导致或加重颈髓损伤而变得复杂。回顾性分析了987例在5年期间需要紧急气管插管的钝性创伤患者的记录，以确定颈椎损伤的发生率和类型，以及基于气道管理的损伤发生率。其中60例患者（6.1%）有颈椎骨折；根据影像学标准，53例为潜在不稳定损伤。20例患者在插管前有神经功能缺损。26例不稳定损伤患者经口插管，25例经鼻插管，2例经环甲膜切开术插管。1例患者在经鼻气管插管后出现神经功能缺损。由于可能存在选择偏倚，即重伤患者被优先转诊至该创伤中心，颈椎损伤的实际发生率可能低于我们所发现的6.1%。作者得出结论，在非常严重受伤的钝性创伤患者群体中，严重颈椎损伤的发生率相对较低，并且常用的预防性气道管理方法很少导致神经功能恶化。
