Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
J Neurosurg Spine. 2012 Sep;17(1 Suppl):38-45. doi: 10.3171/2012.4.AOSPINE1295.
Pulmonary complications are the most common acute systemic adverse events following spinal cord injury (SCI), and contribute to morbidity, mortality, and increased length of hospital stay (LOS). Identification of factors associated with pulmonary complications would be of value in prevention and acute care management. Predictors of pulmonary complications after SCI and their effect on neurological recovery were prospectively studied between 2005 and 2009 at the 9 hospitals in the North American Clinical Trials Network (NACTN).
The authors sought to address 2 specific aims: 1) define and analyze the predictors of moderate and severe pulmonary complications following SCI; and 2) investigate whether pulmonary complications negatively affected the American Spinal Injury Association (ASIA) Impairment Scale conversion rate of patients with SCI. The NACTN registry of the demographic data, neurological findings, imaging studies, and acute hospitalization duration of patients with SCI was used to analyze the incidence and severity of pulmonary complications in 109 patients with early MR imaging and long-term follow-up (mean 9.5 months). Univariate and Bayesian logistic regression analyses were used to analyze the data.
In this study, 86 patients were male, and the mean age was 43 years. The causes of injury were motor vehicle accidents and falls in 80 patients. The SCI segmental level was in the cervical, thoracic, and conus medullaris regions in 87, 14, and 8 patients, respectively. Sixty-four patients were neurologically motor complete at the time of admission. The authors encountered 87 complications in 51 patients: ventilator-dependent respiratory failure (26); pneumonia (25); pleural effusion (17); acute lung injury (6); lobar collapse (4); pneumothorax (4); pulmonary embolism (2); hemothorax (2), and mucus plug (1). Univariate analysis indicated associations between pulmonary complications and younger age, sports injuries, ASIA Impairment Scale grade, ascending neurological level, and lesion length on the MRI studies at admission. Bayesian logistic regression indicated a significant relationship between pulmonary complications and ASIA Impairment Scale Grades A (p = 0.0002) and B (p = 0.04) at admission. Pulmonary complications did not affect long-term conversion of ASIA Impairment Scale grades.
The ASIA Impairment Scale grade was the fundamental clinical entity predicting pulmonary complications. Although pulmonary complications significantly increased LOS, they did not increase mortality rates and did not adversely affect the rate of conversion to a better ASIA Impairment Scale grade in patients with SCI. Maximum canal compromise, maximum spinal cord compression, and Acute Physiology and Chronic Health Evaluation-II score had no relationship to pulmonary complications.
脊髓损伤（SCI）后最常见的急性全身并发症是肺部并发症，会导致发病率、死亡率增加和住院时间延长。确定与肺部并发症相关的因素对预防和急性护理管理具有重要意义。2005 年至 2009 年，北美临床试验网络（NACTN）的 9 家医院前瞻性研究了 SCI 后肺部并发症的预测因素及其对神经恢复的影响。
作者旨在解决两个具体目标：1）定义和分析 SCI 后中重度肺部并发症的预测因素；2）研究肺部并发症是否会对 SCI 患者的美国脊髓损伤协会（ASIA）损伤量表转化率产生负面影响。NACTN 登记了 SCI 患者的人口统计学数据、神经学发现、影像学研究和急性住院时间，用于分析 109 例早期 MRI 检查和长期随访（平均 9.5 个月）患者的肺部并发症发生率和严重程度。使用单变量和贝叶斯逻辑回归分析来分析数据。
在这项研究中，86 名患者为男性，平均年龄为 43 岁。80 名患者的损伤原因是机动车事故和跌倒。87 名患者的 SCI 节段位于颈椎、胸椎和脊髓圆锥，14 名患者位于胸段，8 名患者位于胸段。入院时，64 名患者的神经运动完全完整。作者在 51 名患者中遇到了 87 种并发症：呼吸机依赖呼吸衰竭（26 例）；肺炎（25 例）；胸腔积液（17 例）；急性肺损伤（6 例）；肺叶塌陷（4 例）；气胸（4 例）；肺栓塞（2 例）；血胸（2 例）和黏液栓（1 例）。单变量分析表明，肺部并发症与年龄较小、运动损伤、ASIA 损伤量表分级、神经学上的上升水平以及入院时 MRI 研究中的病变长度有关。贝叶斯逻辑回归表明，肺部并发症与入院时的 ASIA 损伤量表分级 A（p=0.0002）和 B（p=0.04）之间存在显著关系。肺部并发症不会影响 ASIA 损伤量表分级的长期转换。
ASIA 损伤量表分级是预测肺部并发症的基本临床实体。尽管肺部并发症显著增加了住院时间，但它们并未增加死亡率，并且不会对 SCI 患者向更好的 ASIA 损伤量表分级的转化率产生不利影响。椎管最大狭窄、脊髓最大受压和急性生理学和慢性健康评估 II 评分与肺部并发症无关。
