Delayed apnea in patients with mid- to lower cervical spinal cord injury.
Delayed apnea in patients with mid- to lower cervical spinal cord injury.
复制标题
中下颈脊髓损伤患者的延迟性呼吸暂停。
DOI：
10.1097/00007632-200006010-00003
复制
发表时间：
2000
期刊：
影响因子：
3
通讯作者：
H. Chen
中科院分区：
文献类型：
--
作者：
K. Lu;Tao;C. Liang;H. Chen
研究设计
回顾性研究了36例中下颈脊髓损伤（CSCI）患者，根据是否发生迟发性呼吸暂停分为两组。
目标
确定与中下段颈髓损伤后迟发性呼吸暂停发生相关的非肺部危险因素。
背景资料概述
中下段颈髓损伤患者发生呼吸衰竭的风险通常低于高位颈髓损伤患者。表现为突发性呼吸暂停的呼吸衰竭可能在损伤后数天甚至数周发生，此类患者无任何肺部并发症。
方法
一个索引组的8例完全中，下颈脊髓损伤，其中发生延迟灾难性呼吸暂停进行了审查。另一组28例颈髓损伤患者作为对照组，其损伤程度和表现相同，但无呼吸衰竭。分析了可能与迟发性呼吸暂停相关的6个参数。
结果
脊髓病变的范围有显著差异，在大多数指数患者中是弥漫性的，而在大多数对照患者中是局灶性的（P <0.001）。指数组中脊髓C4节段受累似乎更常见;然而，差异无统计学意义（P = 0.091）。指标组一过性心动过缓（P <0.01）和呼吸困难（P <0.001）的发生率明显高于对照组。麻痹性肠梗阻是一种罕见得多的事件，发现与呼吸暂停的发生无关。在8名指数患者中，有5名患者的呼吸暂停发生在睡眠期间。八名患者中有六人死于此。
结论
中、下颈段颈脊髓损伤患者可能会发生延迟性但破坏性的呼吸暂停，即使他们临床稳定且无任何肺部并发症。弥漫性、广泛性脊髓损伤、呼吸窘迫或心动过缓伴或不伴低血压，无论其是否为一过性和自限性，均应视为警告体征。睡眠被认为是一段危险的时间。
STUDY DESIGN
A retrospective study of 36 patients with mid- to lower cervical spinal cord injury (CSCI) divided into two groups based on whether delayed apnea developed.
OBJECTIVES
To determine nonpulmonary risk factors associated with the development of delayed apnea in mid- to lower cervical spinal cord injury.
SUMMARY OF BACKGROUND DATA
Patients with mid- to lower cervical spinal cord injury are generally at lower risk of developing respiratory failure than those with high cervical spinal cord injury. Respiratory failure manifesting as sudden apnea may occur days or even weeks after injury without any pulmonary complications in such patients.
METHODS
An index group of eight patients with complete mid- to lower cervical spinal cord injury in whom delayed catastrophic apnea occurred were reviewed. Another group of 28 patients with cervical spinal cord injury of identical magnitude and presentation but without respiratory failure served as the control group. Six parameters presumed to be related to the delayed apnea were analyzed.
RESULTS
The extent of cord lesions was significantly different, being diffuse in most of the index patients, but focal in the majority of the control patients (P<0.001). Involvement of the C4 segment of cord appeared to be more frequent in the index group; however, the difference was not statistically significant (P = 0.091). The incidence of transient bradycardia (P<0.01) and dyspnea (P<0.001) in the index group was significantly higher than in the control group. Paralytic ileus was a much rarer event and found to be unrelated to the occurrence of apnea. In five of the eight index patients, the apnea occurred during sleep. Six of the eight index patients died of it.
CONCLUSIONS
Delayed but devastating apnea may develop in patients with mid- to lower cervical cervical spinal cord injury, even when they are clinically stable and free from any pulmonary complications. The presence of diffuse, extensive cord lesions, respiratory distress, or bradycardia with or without associated hypotension, however transient and self-limited, should be regarded as warning signs. Sleep was found to be a risky period of time.
影响因子：
4.1
作者：
MARSHALL, LF;KNOWLTON, S;CLIFTON, GL
通讯作者：
CLIFTON, GL