摘要
创伤性颈脊髓损伤(TCSCI)是一种严重的神经系统损伤,常导致呼吸功能障碍,气管切开术是其重要的呼吸管理手段。完全性脊髓损伤、高位损伤(C4及以上)、年龄、损伤严重度及吸烟史等是气管切开的主要预测因素。分类回归树(CART)模型、临床评分系统和列线图工具在预测气管切开中表现出良好的效能。早期气管切开(损伤或插管后7~10 d内)可能缩短ICU住院时间和机械通气时间,但最佳时机仍需进一步研究。气管切开可改善呼吸功能并可能缩短住院时间,但对死亡率的影响尚存争议。因此,本文评述了TCSCI后气管切开的预测因素、预测模型构建、时机选择及其对预后的影响,未来研究应聚焦于大样本多中心前瞻性研究、精准医疗策略及跨学科合作,以优化TCSCI患者的气管切开决策和预后管理。
Traumatic cervical spinal cord injury(TCSCI)is a severe neurological disorder that often leads to respiratory dysfunction,for which tracheostomy serves as a critical respiratory management intervention.This article reviews the predictive factors,model construction,timing selection,and prognostic impact of tracheostomy following TCSCI.Studies indicate that complete spinal cord injury,high-level injury(C4 and above),age,injury severity,and smoking history are key predictors for tracheostomy.The Classification and Regression Tree(CART)model,clinical scoring systems,and nomogram tools demonstrate strong efficacy in predicting the need for tracheostomy.Early tracheostomy(within 7–10 days post-injury or intubation)may reduce ICU stay duration and mechanical ventilation time,though the optimal timing requires further investigation.While tracheostomy can improve respiratory function and potentially shorten hospitalization,its impact on mortality remains debated.Future research should focus on large-scale,multicenter prospective studies,precision medicine strategies,and interdisciplinary collaboration to optimize tracheostomy decision-making and prognostic management for TCSCI patients.
作者
张正丰
ZHANG Zhengfeng(Department of Orthopedics,Fuling Hospital,Chongqing University,Chongqing 408099,China)
出处
《西部医学》
2025年第8期1093-1096,1102,共5页
Medical Journal of West China
基金
国家自然科学基金项目(81572210)。
关键词
创伤性颈脊髓损伤
气管切开
预测因素
时机选择
预后
Traumatic cervical spinal cord injury
Tracheostomy
Predictive factors
Timing selection
Prognosis
