Respiratory complications and mortality risk associated with thoracic spine injury
Respiratory complications and mortality risk associated with thoracic spine injury
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DOI：
10.1097/01.ta.0000196005.49422.e6
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发表时间：
2005-12-01
影响因子：
--
通讯作者：
Schwab, CW
中科院分区：
文献类型：
--
作者：
Cotton, BA;Pryor, JP;Schwab, CW
背景：颈脊髓损伤（SCI）与呼吸系统并发症的高风险有着明确的联系。我们试图确定是否高胸（HT）SCI与呼吸系统并发症和death.Methods的风险增加类似：这是一个回顾性队列研究的所有成年患者胸腰椎损伤进入宾夕法尼亚州创伤系统基金会注册1993年1月至2002年12月。对记录进行审查，以记录呼吸并发症（插管、气管造口术、支气管镜检查、肺炎）和死亡率。然后对数据进行评估，控制年龄，性别，格拉斯哥昏迷量表和损伤严重程度Score.Results：在所有，11,080例患者符合纳入标准：4,258例胸椎骨折和6,226例腰椎骨折，所有无SCI;和596例患者胸椎SCI（T1至T6，231; T7至T12，365）。51.1%的T1至T6 SCI患者发生呼吸系统并发症（T7至T12 SCI为34.5%，胸部骨折为27.5%）。T1-T6脊髓损伤患者的插管需求、肺炎风险和死亡风险显著更高。在损伤严重度评分小于17的患者中（n = 6427），发生呼吸系统并发症的患者的相对死亡风险是其他患者的26.7倍（9.9%对0.4%）。结论：与下胸椎SCI或胸腰椎骨折患者相比，HT-SCI患者的肺炎和死亡风险增加。呼吸系统并发症显著增加了不太严重损伤患者的死亡风险。目前的研究结果表明，HT-SCI患者需要加强监测和积极的肺部护理和关注，类似于颈椎SCI患者。
Background: Cervical spinal cord injury (SCI) has a well-established association with a high risk of respiratory complications. We sought to determine whether high-thoracic (HT) SCI was associated with a similar increased risk of respiratory complications and death.Methods: This was a retrospective cohort study of all adult patients with thoracolumbar injuries entered into the Pennsylvania Trauma System Foundation registry between January 1993 and December 2002. Records were reviewed for the documentation of respiratory complications (intubation, tracheostomy, bronchoscopy, pneumonia) and mortality. The data were then evaluated controlling for age, sex, Glasgow Coma Scale, and Injury Severity Score.Results: In all, 11,080 patients met inclusion criteria: 4,258 patients had thoracic spine fractures and 6,226 patients had lumbar spine fractures, all without SCI; and 596 patients had thoracic SCI (T1 to T6, 231; T7 to T12, 365). Respiratory complications occurred in 51.1% of patients with T1 to T6 SCI (versus 34.5% in T7 to T12 SCI and 27.5% in thoracic fractures). The need for intubation, the risk of pneumonia, and risk of death were significantly greater for patients with T1- to T6-level spinal cord injuries. Among patients with an Injury Severity Score less than 17 (n = 6427), the relative mortality risk was 26.7 times higher among those who developed respiratory complications (9.9% versus 0.4%).Conclusion: Compared with patients with low thoracic SCI or thoracolumbar fractures, patients with HT-SCI have an increased risk of pneumonia and death. Respiratory complications significantly increase the mortality risk in less severely injured patients. The current findings suggest that HT-SCI patients warrant intensive monitoring and aggressive pulmonary care and attention, similar to that given for patients with cervical SCI.