Claxton A R, Wong D T, Chung F, Fehlings M G
Department of Anaesthesia, University of Toronto, Ontario, Canada.
Can J Anaesth. 1998 Feb;45(2):144-9. doi: 10.1007/BF03013253.
The objective of this study was to identify predictors of death and mechanical ventilation in patients with traumatic cervical spinal cord injury.
From 1981 to 1994, 72 patients with traumatic cervical spinal cord injury resulting in neurological deficits were identified in this retrospective study. For each patient, neurological and associated injuries, physiological variables, complications, hospital mortality and the need for mechanical ventilation were recorded. Univariate and multivariate logistic regression analyses were done to identify predictors of mortality and the need for mechanical ventilation.
Fifteen patients (21%) died in the first three months after injury. Univariate analyses identified age, heart disease, neurological level at C4 and above, GCS < or = 13, forced vital capacity and cough, to be associated with mortality. Multivariate logistic regression identified age (P = 0.01), neurological level (P = 0.03) and GCS (P = 0.05) as independent predictors of mortality. In 41 patients (57%), the lungs were mechanically ventilated. Univariate analyses identified. The following predictors of the need for mechanical ventilation: neurological level at C5 and above, complete cord lesions, copious sputum, pneumonia and lung collapse. Multivariate logistic regression identified copious sputum (P = 0.01) and pneumonia (P = 0.01) as independent predictors of the need for mechanical ventilation.
Age, neurological level and GCS are independent predictors of mortality in patients with traumatic cervical spinal cord injury. Copious sputum and pneumonia are independent predictors of the need for mechanical ventilation.
本研究的目的是确定创伤性颈脊髓损伤患者死亡和机械通气的预测因素。
在这项回顾性研究中，从1981年至1994年共确定了72例因创伤性颈脊髓损伤导致神经功能缺损的患者。记录每位患者的神经和相关损伤、生理变量、并发症、医院死亡率以及机械通气需求。进行单因素和多因素逻辑回归分析以确定死亡率和机械通气需求的预测因素。
15例患者（21%）在受伤后的前三个月死亡。单因素分析确定年龄、心脏病、C4及以上神经平面、格拉斯哥昏迷评分（GCS）≤13、用力肺活量和咳嗽与死亡率相关。多因素逻辑回归确定年龄（P = 0.01）、神经平面（P = 0.03）和GCS（P = 0.05）是死亡率的独立预测因素。41例患者（57%）接受了机械通气。单因素分析确定了以下机械通气需求的预测因素：C5及以上神经平面、脊髓完全损伤、大量痰液、肺炎和肺萎陷。多因素逻辑回归确定大量痰液（P = 0.01）和肺炎（P = 0.01）是机械通气需求的独立预测因素。
年龄、神经平面和GCS是创伤性颈脊髓损伤患者死亡率的独立预测因素。大量痰液和肺炎是机械通气需求的独立预测因素。
