Predictors of hospital mortality and mechanical ventilation in patients with cervical spinal cord injury
Predictors of hospital mortality and mechanical ventilation in patients with cervical spinal cord injury
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DOI：
10.1007/bf03013253
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发表时间：
1998-02-01
期刊：
影响因子：
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通讯作者：
Fehlings, MG
中科院分区：
文献类型：
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作者：
Claxton, AR;Wong, DT;Fehlings, MG
目的：本研究的目的是确定外伤性颈脊髓损伤患者死亡和机械通气的预测因素。方法：对1981 ~ 1994年72例外伤性颈脊髓损伤患者的神经功能缺损进行回顾性分析。记录每位患者的神经及相关损伤、生理变量、并发症、住院死亡率和机械通气需求。进行单因素和多因素logistic回归分析，以确定死亡率和机械通气需求的预测因素。结果：15例（21%）患者在受伤后的前3个月内死亡，单因素分析确定年龄、心脏病、C-4及以上的神经水平、GCS小于或等于13、用力肺活量和咳嗽与死亡率相关。多因素logistic回归发现年龄（P = 0.01）、神经系统水平（P = 0.03）和GCS （P = 0.05）是死亡率的独立预测因子。41例（57%）患者采用机械通气。单变量分析确定了需要机械通气的以下预测因素：C-5及以上的神经水平，完全的脊髓病变，大量痰，肺炎和肺衰竭。多因素logistic回归发现痰多（P = 0.01）和肺炎（P = 0.01）是机械通气需求的独立预测因素。结论：年龄、神经学水平和GCS是外伤性颈脊髓损伤患者死亡率的独立预测因子。痰多和肺炎是需要机械通气的独立预测因子。
Purpose: The objective of this study was to identify predictors of death and mechanical ventilation in patients with traumatic cervical spinal cord injury.Methods: 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 muiltivariate logistic regression analyses were done to identify predictors of mortality and the need for mechanical ventilation.Results: Fifteen patients (21 %) died in The first three months after injury Univariate analyses identified age, heart disease, neurological level at C-4 and above, GCS less than or equal to 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 C-5 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.Conclusion: 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.