Sun Lin, Feng Haoyu, Mei Jun, Wang Zhiqiang, Deng Chen, Qin Zhixin, Lv Junqiao
Department of Orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.
Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Surg. 2023 Mar 17;9:1082428. doi: 10.3389/fsurg.2022.1082428. eCollection 2022.
Complete cervical spinal cord injury (CSCI) is a devastating injury that usually requires surgical treatment. Tracheostomy is an important supportive therapy for these patients. To evaluate the effectiveness of early one-stage tracheostomy during surgery compared with necessary tracheostomy after surgery, and to identify clinical factors for one-stage tracheostomy during surgery in complete cervical spinal cord injury.
Data from 41 patients with complete CSCI treated with surgery were retrospectively analyzed.
Ten patients (24.4%) underwent one-stage tracheostomy during surgery, thirteen (31.7%) underwent tracheostomy when necessary after surgery, and eighteen (43.9%) did not have a tracheostomy.
One-stage tracheostomy during surgery significantly reduced the development of pneumonia at 7 days after tracheostomy ( = 0.025), increased the PaO ( < 0.05), and decreased the length of mechanical ventilation ( = 0.005), length of stay (LOS) in the intensive care unit (ICU) ( = 0.002), hospital LOS ( = 0.01) and hospitalization expenses compared with necessary tracheostomy after surgery ( = 0.037). A high neurological level of injury (NLI) (NLI C5 and above), a high PaCO in the blood gas analysis before tracheostomy, severe breathing difficulty, and excessive pulmonary secretions were the statistically significant factors for one-stage tracheostomy during surgery in the complete CSCI patients, but no independent clinical factor was found.
In conclusion, one-stage tracheostomy during surgery reduced the number of early pulmonary infections and the length of mechanical ventilation, ICU LOS, hospital LOS and hospitalization expenses, and one-stage tracheostomy should be considered when managing complete CSCI patients by surgical treatment.
完全性颈脊髓损伤（CSCI）是一种严重损伤，通常需要手术治疗。气管切开术是这些患者的重要支持性治疗方法。比较手术中早期一期气管切开术与术后必要时气管切开术的有效性，并确定完全性颈脊髓损伤患者手术中一期气管切开术的临床因素。
回顾性分析41例接受手术治疗的完全性CSCI患者的数据。
10例患者（24.4%）在手术中接受一期气管切开术，13例（31.7%）在术后必要时接受气管切开术，18例（43.9%）未进行气管切开术。
与术后必要时气管切开术相比，手术中一期气管切开术显著降低了气管切开术后7天肺炎的发生率（=0.025），提高了动脉血氧分压（<0.05），并缩短了机械通气时间（=0.005）、重症监护病房（ICU）住院时间（=0.002）、住院总时间（=0.01）和住院费用（=0.037）。损伤神经平面高（NLI）（NLI为C5及以上）、气管切开术前血气分析中动脉血二氧化碳分压高、严重呼吸困难和肺分泌物过多是完全性CSCI患者手术中一期气管切开术的统计学显著因素，但未发现独立的临床因素。
总之，手术中一期气管切开术减少了早期肺部感染的数量，缩短了机械通气时间、ICU住院时间、住院总时间和住院费用，在通过手术治疗管理完全性CSCI患者时应考虑一期气管切开术。
