Department of Otolaryngology, Unfallkrankenhaus Berlin, Warener Strasse 7, 12683, Berlin, Germany.
Eur Spine J. 2010 Jul;19(7):1073-8. doi: 10.1007/s00586-010-1328-7. Epub 2010 Feb 24.
The objective of this study was to develop an evidence-based airway management protocol for patients with acute tetraplegia. The method consisted of an analysis of the medical records of patients (September 1997-December 2002) with a spinal cord injury and a neurological deficit less than 8 weeks old. Of the 175 patients, 72 (41, 14%) were tracheotomised. This was influenced by the origin of the paralysis, Frankel score, and number of cervical spine operations, accompanying injuries and accompanying illnesses. Tracheotomy did not affect the duration of treatment, duration of ventilation or length of stay in the intensive care unit. The need for a tracheotomy was able to be predicted in 73.31% with neurological level, Frankel score and severity of accompanying injuries. In patients with acute tetraplegia, primary tracheotomy is indicated in sub C1-C3 with Frankel stage A/B, sub C4-C6 with Frankel stage A/B with trauma and accompanying injuries/accompanying illnesses, and in patients with complex cervical spine trauma that requires a combined surgical approach. In other patients, an attempt at extubation should be made.
本研究旨在为急性四肢瘫痪患者制定基于循证的气道管理方案。该方法包括对脊髓损伤和神经功能缺损少于 8 周的患者（1997 年 9 月至 2002 年 12 月）的病历进行分析。在 175 名患者中，72 名（41%，14%）进行了气管切开术。这与瘫痪的起源、Frankel 评分、颈椎手术次数、伴随损伤和伴随疾病有关。气管切开术并不影响治疗时间、通气时间或重症监护病房的住院时间。神经水平、Frankel 评分和伴随损伤的严重程度可以预测 73.31%的患者需要进行气管切开术。对于急性四肢瘫痪患者，Frankel 分期 A/B 的 C1-C3 以下、Frankel 分期 A/B 的 C4-C6 以下合并创伤和伴随损伤/伴随疾病、需要联合手术入路的复杂颈椎创伤患者，建议行原发性气管切开术。对于其他患者，应尝试进行拔管。
