Hawayek Bradley, Lucasti Christopher, Patel Dil, Maraschiello Mark, Kowalski Joseph
University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
University at Buffalo Orthopaedics and Sports Medicine, Buffalo, NY, USA.
J Spine Surg. 2021 Jun;7(2):233-237. doi: 10.21037/jss-20-669.
Cardiac asystole following cervical spine injury is rare and occurs after approximately 15-16% of cases of high spinal cord injury. While incidence of cardiac abnormalities after high spinal cord injury typically peak at 4-7 days following the initial injury, they have been reported to take up to 2-6 weeks to resolve. In our case the patient was found unresponsive in the field with pulseless cardiac activity. She had return of spontaneous circulation after a short period of cardiopulmonary resuscitation (CPR) and was transferred to the trauma intensive care unit (ICU) where she developed progressive motor and sensory deficits and was found to have anterior subluxation of C2 and C3 as well as fractures of the C2 and C3 vertebrae that were treated with decompression and C1-5 fusion. She has done well post-operatively and has had no further cardiac abnormalities since the time of her initial injury. The authors believe that patients that experience cardiac asystole secondary to high spinal cord injury who have rapid recovery of cardiac function can be managed with appropriate monitoring without medical management with inotropic agents or cardiac pacemaker implantation, and surgery to address neurologic deficits should not be delayed.
颈椎损伤后发生心搏停止较为罕见，约15 - 16%的高位脊髓损伤病例会出现这种情况。虽然高位脊髓损伤后心脏异常的发生率通常在初始损伤后4 - 7天达到峰值，但据报道其恢复时间长达2 - 6周。在我们的病例中，患者在现场被发现无反应且心脏无脉搏活动。经过短时间的心肺复苏（CPR）后恢复了自主循环，并被转至创伤重症监护病房（ICU），在那里她出现了进行性运动和感觉功能障碍，被发现有C2和C3椎体前半脱位以及C2和C3椎骨骨折，接受了减压和C1 - 5融合治疗。她术后恢复良好，自初次受伤以来未再出现心脏异常。作者认为，因高位脊髓损伤继发心搏停止且心脏功能快速恢复的患者，可通过适当监测进行管理，无需使用强心剂或植入心脏起搏器进行药物治疗，并且不应延迟针对神经功能缺损的手术治疗。
