摘要
目的 探讨C3、4以上外伤性不稳伴高位脊髓神经损伤手术治疗出现呼吸衰竭的防治方法。方法 对 17例C3、4以上外伤性不稳伴高位脊髓神经损伤发生呼吸衰竭手术治疗的患者进行回顾性分析。脊髓神经损伤按ASIA分级 :A级 6例 ,B级 8例 ,C级 3例。手术方法 :前路钢板内固定术 6例 ,后路 11例。术前诊断呼吸功能不全 6例 ,术中 9例 ,术后 2例。其中 1例术后需呼吸机辅助呼吸达 6周 ,2例出现心跳减慢、停跳 ,反复 5～ 6次 ,最后抢救成功。结果 15例平均随访 13个月 ,效果良好 ,2例于出院后 3个月内死亡。结论 对外伤性C3、4以上不稳并高位脊髓神经损伤手术的高危病例 ,在保护脊髓治疗的基础上 ,先处理严重的多发伤及并发症。伤后积极综合治疗 5～ 7d再行脊柱手术 ,术后常规应用镇痛泵、避免呼吸抑制药物、尽早应用机械辅助呼吸。
Objective To investigate the prevention and treatment of respiratory failure caused by upper cervical injuries.Methods The documents of 17 patients with respiratory failure caused by upper cervical injuries were retrospectively analyzed.According to ASIA classification,6 cases were in Grade A,8 in Grade B and 3 in Grade C.All patients were treated with operations by anterior or posterior approaches.Respiratory failure was appeared in 2 cases before operation,in 9 cases during operation and in 2 cases after operation.One case needed auxiliary respiration by machine for six weeks while bradycardia and cardiac arrest occurred on 5 to 6 times in other 2 cases,all these three patients were saved successfully.Results Two cases died in 3 months after operations.Other 15 cases were followed up for 13 months on average and had good results.Conclusion For patients with upper cervical injuries,the treatment on protecting spinal cord and on administering complications should be given at first.After 5～7 days from the time of injuries,the patient is treated with operation under tracheal intubation anesthesia.After operation,using respiratory auxiliary system and avoiding respiratory inhibition drugs are important to prevent and to treat respiratory failure.
出处
《中国骨与关节损伤杂志》
2005年第2期82-83,共2页
Chinese Journal of Bone and Joint Injury
