Nörolojik bozuklukla birlikte üst seviye servikal spinal kord yaralanması bulunan hastalarda solunum komplikasyonları risk faktörlerinin saptanması

Abstract

Amaç: Üst servikal omurga yaralanması (SOY) bulunan hastalarda solunum yolu komplikasyonlarının klinik özellikleri, bölgenin karmaşık anatomisi nedeniyle kendine özgüdür. Bu çalışmanın amacı üst SOY ve servikal spinal kord yaralanması (S-SKY) bulunan hastalarda solunum komplikasyonlarına yönelik risk faktörlerini saptamaktı. Çalışma planı: Çalışmaya alınma kriteri olan üst servikal omurga yaralanması nedeniyle 1992 ile 2010 yılları arasında hospitalize edilmiş (omurga yaralanması bulunan 1593 hasta arasından) 92 hastanın kayıtları geriye dönük olarak incelendi. Bulgular: Toplam 16 hastada (%17.4) solunum komplikasyonuna rastlandı. Buna ek olarak, ventilatörle ilişkili pnömoni solunum komplikasyonlarında önemli rol oynamıştı, ancak, pulmoner tromboembolizm saptanmadı. Solunum komplikasyonu bulunana gruptaki ölüm oranı (SKG, %31.3), solunum yolu komplikasyonu bulunmayan gruptakinden daha yüksekti (SKBG, %1.3). SKG’de lojistik regresyon analiziyle şiddetli S-SKY (Amerikan Spinal Kord Yaralanmaları Derneği Derece A ve B, OR=34.401; %95 GA, 2.609-5.525) ve hipoalbümineminin (OR=24.616; %95 GA, 1.492-6.182) solunum komplikasyonlarına yönelik ana risk faktörleri olduğu; öte yandan nörolojik yaralanma, kuadripleji, atlanto-aksiyel kırıklar, sigara içme öyküsü ve elektrolit bozukluklarının seviyelerinin (solunum komplikasyonlarıyla istatistiksel açıdan ilişkili olsa da) risk faktörü oluşturmadığı saptandı. Çıkarımlar: Şiddetli S-SKY ve hipoalbuminemi, üst seviye SKY ve nörolojik bozukluk bulunan hastalarda solunum komplikasyonlarının öngörülmesinde önemli rol oynamıştır. Bunun yanı sıra, nörolojik yaralanma, kuadripleji, atlanto-aksiyel kırıklar, sigara içme öyküsü ve elektrolit bozukluklarının seviyeleri de bu komplikasyonlar açısından değerli göstergelerdir. Buna ek olarak, ventilatör ilişkili pnömoninin önlenmesi de bu hastaların tedavisi açısından çok önemlidir. Ancak hastalarda derin ven trombozu taraması yapılmasının gereksiz olduğu anlaşılmıştır.

Keywords

• Omurga cerrahisi; omurga yaralanması; servikal omurga.

Identification of risk factors for respiratory complications in upper cervical spinal injured patients with neurological impairment

Abstract

Objective: Clinical features of respiratory complications in patients with upper cervical spine injuries (CSI) are unique due to the complex regional anatomy in the region. The objective of this study was to identify the risk factors for respiratory complications in the patients with upper CSI and cervical spinal cord injuries (C-SCI).
Methods: Ninety-two patients (out of 1593 spine injured patients) who met the inclusion criteria of upper CSI were admitted to our hospital from 1992 to 2010. Their records were retrospectively reviewed.
Results: Respiratory complications occurred in 16 patients (17.4%). In addition, ventilator-associated pneumonia played an important role in the respiratory complications, however, no pulmonary thromboembolism was found. Death rate in respiratory complication group (RCG, 31.3%) was significantly higher than that in non-respiratory complication group (NCG, 1.3%). In RCG, severe C-SCI
(American Spinal Cord Injury Association Grades A and B, OR=34.401; 95% CI, 2.609-5.525) and hypoalbuminemia (OR=24.616; 95% CI, 1.492-6.182) were identified by logistic regression analysis as main risk factors for respiratory complications; whereas levels of neurological injury, quadriplegia, atlanto-axial fractures, smoking history, and electrolyte disturbances were not identified as risk factors (although statistically relevant to respiratory complications).
Conclusion: Severe C-SCI and hypoalbuminemia played important roles in predicting respiratory complications among the patients with upper CSI and neurological impairment. In addition, levels of neurological injury, quadriplegia, atlanto-axial fractures, smoking history, and electrolyte disturbances are also valuable indicators for these complications. Moreover, prevention of ventilator-associated pneumonia was crucial in the treatment of these patients. However, a screening for deep venous thrombosis was seemingly unnecessary in our patients.

Keywords

• Cervical spine
• spine injury
• spine surgery

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