颈椎创伤性瘫痪围手术期腹胀的临床相关因素分析
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摘要
目的探讨颈椎创伤性瘫痪患者围手术期腹胀的临床相关因素,为其早期预防和治疗提供必要依据。方法回顾性分析2009-06-2011-06在本院脊柱外科收治的92例颈髓损伤致瘫痪患者的临床资料。记录入选对象出现的一般情况、神经损害程度(采用美国脊髓损伤协会的ASIA分级)、围手术期腹胀发生情况(结合主观感受、腹部平片、进食情况、腹部叩诊等指标)、术后首次排气时间、排便、镇痛泵使用情况等内容,对结果进行相关危险因素分析。结果 92例患者中有65%(60/92)出现不同程度的腹胀症状,其中,高龄、神经功能损害程度高、术后首次排气时间长、术后使用镇痛泵时间超过24 h等为围手术期出现腹胀的危险因素。结论颈椎创伤性瘫痪患者围手术期出现腹胀的发生率高,对于具有高危因素的重点患者需要进行及时的针对性救治,可改善预后,提高患者生存质量。
Objective To explore the clinically relevant factors of abdominal distension in perioperative stage in patients with cervical traumatic paraplegia and to provide the early prevention and treatment for this disease. Methods To retrospectively analyze the clinical data of 92 cases with cervical traumatic paraplegia in our hospital from June 2009 to June 2011. We recorded the details of included cases such as the general information, neurological injury(ASIA grade),abdominal distension during perioperative stage(through subjective feeling, abdominal X ray, diet and percussion), initial fart time, defecation and duration of analgesia pump using. And these information was used to analyze the risk factors between them. Results There were 65%(60/92) patients appeared different degree of symptoms of abdominal distension. Among them,the old age, high degree of neurological injury, initial fart time, duration of analgesia pump using over 24 h were the important risk factors for abdominal distension that appeared during perioperation. Conclusion The incidence of abdominal distension of cervical traumatic paraplegia patients during perioperative period is high, for patients with these risk factors mentioned above need to be treated timely, which can improve the quality of survival.
Objective To explore the clinically relevant factors of abdominal distension in perioperative stage in patients with cervical traumatic paraplegia and to provide the early prevention and treatment for this disease. Methods To retrospectively analyze the clinical data of 92 cases with cervical traumatic paraplegia in our hospital from June 2009 to June 2011. We recorded the details of included cases such as the general information, neurological injury(ASIA grade),abdominal distension during perioperative stage(through subjective feeling, abdominal X ray, diet and percussion), initial fart time, defecation and duration of analgesia pump using. And these information was used to analyze the risk factors between them. Results There were 65%(60/92) patients appeared different degree of symptoms of abdominal distension. Among them,the old age, high degree of neurological injury, initial fart time, duration of analgesia pump using over 24 h were the important risk factors for abdominal distension that appeared during perioperation. Conclusion The incidence of abdominal distension of cervical traumatic paraplegia patients during perioperative period is high, for patients with these risk factors mentioned above need to be treated timely, which can improve the quality of survival.
引文
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[13]Sarlfakloglu B,Afsar SI,Yalbuzdag SA,et al.Acute abdominal emergencies and spinal cord injury;our experiences:a retrospective clinical study[J].Spinal Cord,2014,52(9):697-700.
[14]Tong M,Holmes GM.Gastric dysreflexia after acute experimental spinal cord injury in rats[J].Neurogastroenterol Motil,2009,21(2):197-206.
[15]Krassioukov AV,Furlan JC,Fehlings MG.Autonomic dysreflexia in acute spinal cord injury:an under-recognized clinical entity[J].J Neurotrauma,2003,20(8):707-716.
[2]Hou S,Alexander GR.Autonomic consequences of spinal cord injury[J].Compr Physiol,2014,4(4):1419-1453.
[3]Saltzstein RJ,Mustin E,Koch TR.Gut hormone release in patients after spinal cord injury[J].Am J Phys Med Rehabil,1995,74(5):339-344.
[4]井永敏,丁俊琴,张秀果,等.外伤性颈髓损伤患者早期并发症与损伤程度的相关性[J].中国脊柱脊髓杂志,2012,22(11):999-1003.
[5]Stone JM,Wolfe VA,Nino-Murcia M,et al.Colostomy as treatment for complications of spinal cord injury[J].Arch Phys Med Rehabil,1990,71(7):514-518.
[6]Ozisler Z,Koklu K,Ozel S,et al.Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction[J].Neural Regen Res,2015,10(7):1153-1158.
[7]白春宏,王莎莉,安洪,等.急性脊髓损伤后家兔肠道菌群移位和内毒血症的肠道病理生理机制[J].第三军医大学学报,2010,32(6):580-583.
[8]姜树东,洪毅,张军卫,等.脊髓损伤后恢复瘫痪膈肌功能的治疗方法及效果[J].中国脊柱脊髓杂志,2012,22(3):287-288.
[9]Ayas S,Leblebici B,Sozay S,et al.The effect of abdominal massage on bowel function in patients with spinal cord injury[J].Am J Phys Med Rehabil,2006,85(12):951-955.
[10]Suttor VP,Ng C,Rutkowski S,et al.Colorectal responses to distension and feeding in patients with spinal cord injury[J].Am J Physiol Gastrointest Liver Physiol,2009,296(6):G1344-1349.
[11]Han TR,Kim JH,Kwon BS.Chronic gastrointestinal problems and bowel dysfunction in patients with spinal cord injury[J].Spinal Cord,1998,36:485-490.
[12]韩卢丽,王凤英,孙群周,等.急性颈髓损伤并低钠血症的临床分析[J].中国脊柱脊髓杂志,2009,1:19-21.
[13]Sarlfakloglu B,Afsar SI,Yalbuzdag SA,et al.Acute abdominal emergencies and spinal cord injury;our experiences:a retrospective clinical study[J].Spinal Cord,2014,52(9):697-700.
[14]Tong M,Holmes GM.Gastric dysreflexia after acute experimental spinal cord injury in rats[J].Neurogastroenterol Motil,2009,21(2):197-206.
[15]Krassioukov AV,Furlan JC,Fehlings MG.Autonomic dysreflexia in acute spinal cord injury:an under-recognized clinical entity[J].J Neurotrauma,2003,20(8):707-716.