Butler Thomas, Shin Susanna, Collins Jay, Britt Rebecca C, Reed Scott F, Weireter Leonard J, Britt L D
Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.
Am Surg. 2011 Apr;77(4):426-9.
Body surfing accidents (BSA) can cause cervical spinal cord injuries (CSCIs) that are associated with near-drowning (ND). The submersion injury from a ND can result in aspiration and predispose to pulmonary complications. We predicted a worse outcome (particularly the development of pneumonia) in patients with CSCIs associated with ND. A retrospective review was performed of patients who were treated at Eastern Virginia Medical School for a CSCI resulting from a blunt mechanism. Data collected included basic demographic data, data regarding injury and in-hospital outcomes, and discharge data, including discharge disposition. Statistics were performed using χ(2) and Student t test. In 2003 to 2008, 141 patients were treated for CSCIs with inclusion criteria. Thirty patients (21%) had an associated ND (BSA) and 111 patients (79%) did not (BLT). The cohorts were similar in mean age (BSA, 45 years; BLT, 50 years; P = 0.16) and male gender distribution (BSA, 93%; BLT, 79%; P = 0.13). The cohorts were similar in injury severity using Injury Severity Score (BSA, 22; BLT, 24; P = 0.65). The cohorts were similar in rates of developing pneumonia (BSA, 3%; BLT, 12%; P = 0.31). The rate of infection was significantly higher in the cohort without an associated near-drowning (BSA, 10%; BLT, 32%; P = 0.033). The mean intensive care unit stay (BSA, 3.5 days; BLT, 11.3 days; P = 0.057) and the rate of mortality were similar (BSA, 10%; BLT, 10% P = 0.99). Those patients with an associated ND had a shorter hospital stay (BSA, 5.7 days; BLT, 22.2 days; P = 0.007) and a better chance of being discharged home (BSA, 57%; BLT, 27%; P = 0.004). CSCIs after a BSA do better than their counterparts without an associated ND. CSCIs associated with ND appear to be isolated injuries with minimal pulmonary involvement despite submersion injuries.
人体冲浪事故（BSA）可导致与近乎溺水（ND）相关的颈脊髓损伤（CSCI）。近乎溺水造成的浸没性损伤可导致误吸并易引发肺部并发症。我们预测，与近乎溺水相关的颈脊髓损伤患者的预后更差（尤其是肺炎的发生）。对在东弗吉尼亚医学院接受治疗的因钝性机制导致颈脊髓损伤的患者进行了回顾性研究。收集的数据包括基本人口统计学数据、损伤及住院结局相关数据以及出院数据，包括出院处置情况。使用χ²检验和学生t检验进行统计学分析。在2003年至2008年期间，141例符合纳入标准的颈脊髓损伤患者接受了治疗。30例患者（21%）伴有近乎溺水（人体冲浪事故），111例患者（79%）未伴有（钝性创伤）。两组在平均年龄（人体冲浪事故组，45岁；钝性创伤组，50岁；P = 0.16）和男性性别分布（人体冲浪事故组，93%；钝性创伤组，79%；P = 0.13）方面相似。使用损伤严重度评分评估，两组在损伤严重程度方面相似（人体冲浪事故组，22分；钝性创伤组，24分；P = 0.65）。两组在肺炎发生率方面相似（人体冲浪事故组，3%；钝性创伤组，12%；P = 0.31）。在未伴有近乎溺水的组中感染率显著更高（人体冲浪事故组，10%；钝性创伤组，32%；P = 0.033）。平均重症监护病房住院时间（人体冲浪事故组，3.5天；钝性创伤组，11.3天；P = 0.057）和死亡率相似（人体冲浪事故组，10%；钝性创伤组，10%；P = 0.99）。伴有近乎溺水的患者住院时间较短（人体冲浪事故组，5.7天；钝性创伤组，22.2天；P = 0.007），且出院回家的可能性更大（人体冲浪事故组，57%；钝性创伤组，27%；P = 0.004）。人体冲浪事故后发生的颈脊髓损伤比未伴有近乎溺水的同类损伤恢复得更好。与近乎溺水相关的颈脊髓损伤似乎是孤立性损伤，尽管存在浸没性损伤，但肺部受累程度最小。
