关键词: 创伤性颈髓损伤, 呼吸系统并发症, 创伤严重程度评分, 临床肺部感染评分, 危险因素, 影响因素分析

Abstract: Background　Acute traumatic cervical spinal cord injury（TCSCI） can lead to diaphragmatic paralysis，impairing the breathing exercises.Such patients need surgical treatment to reduce the incidence of respiratory complications and improve prognosis.However，the risk factors for respiratory complications within 1 week after acute TCSCI have been rarely studied.Objective　To assess the risk factors for respiratory complications occurred within 1 week after acute TCSCI.Methods　Participants were 74 cases of acute TCSCI who received treatment in the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University during November 2016 to July 2018 and a 3-month follow-up，including 43 with respiratory complications within 1 week after acute TCSCI（disease group），and 31 without（control group）.A retrospective analysis was performed on their data about sex，age，BMI，history of smoking，comorbidities（hypertension，diabetes），pathogeny，level of spinal cord injury and ASIA motor score evaluated by the ASIA Impairment Scale，prevalence of injury，anatomic level of injury，Injury Severity Score（ISS），Clinical Pulmonary Infection Score（CPIS），treatment regimen，surgical approach and duration，length of stay，and prevalence of dropout.Multivariate Logistic regression model was used to analyze the variables possibly associated with respiratory complications after acute TCSCI.Results　 Of the 43 cases（58.1%） with respiratory complications，5 had pneumonia，1 had pulmonary edema，and 37 had mechanical ventilation.Mechanical ventilation was performed preoperatively in 31 cases（21 cases via endotracheal tube，and 10 via tracheotomy）.The disease group had higher prevalence of complete spinal cord injury，higher prevalence of coexisted injuries，lower mean ASIA motor score，higher mean ISS and CPIS，and higher rate of having surgery using a posterior approach，as well as longer mean length of stay compared with the control group（P<0.05）.Multivariate Logistic regression analysis the level of spinal cord injury 〔OR=3.290，95%CI（1.214，6.862）〕，AMS score〔OR=2.430，95%CI（1.103，5.436）〕，CPIS〔OR=1.235，95%CI（1.036，3.264）〕，and surgical approach〔OR=1.225，95%CI（1.033，3.106）〕 were independent factors associated with for respiratory complications within 1 week after acute TCSCI（P<0.05）.Conclusion　 The level of spinal cord injury and ASIA motor score evaluated by the ASIA Impairment Scale，CPIS and surgical approach are independent factors predicting respiratory complications after acute TCSCI.Early enhanced respiratory management and active mechanical ventilation should be given to those with complete spinal cord injury，higher AMS or CPIS，and having the surgery via a posterior approach.

Key words: Traumatic cervical spinal cord injury, Respiratory complications, Injury Severity Score, Clinical pulmonary infection score, Risk factors, Root cause analysis