Analysis Of Risk Factors Of Respiratory Failure After Cervical Spinal Cord Injury

Objective To analyse the risk factors of respiratory failure after cervical spinal cord injury.Methods A total 294 patients from January 2009 to December 2013 were retrospectively analyzed. Patients were divided into two groups by whether combined with respiratory failure. The indexes were analyzed as following: gender, age, occupation, cause of injury, fracture with dislocation, multiple trauma, cervical spinal cord injury plane and grade of ASIA.ResultsIn these 294 cervical spinal cord injury patients, 243 cases were male patients(82.7%) and 51 cases were female patients(17.3%). The average age were 48.86±14.71 years old. The average hospital stay days were 25.03±22.15, ranged from 1-128 days. The falls(114 cases;38.8%) and automobile accidents(71 cases; 24.1%)were the main causes of injury. C4-5 injury was the most common level with 195 cases(66.3%). The complete injury(class A) and incomplete injury(grade B, C, D) were47 cases(16.0%) and 247 cases(84.0%), respectively, according to American spinal injury association(ASIA) evaluation method.Fifty two cases(17.7%) were combined with respiratory failure after cervical spinal cord injury.45 cases were male patients(86.5%) and 7 cases were female patients(13.5%), the average age were 52.6±14.3 years old.The average hospital stay days were 36.1±31.4, ranged from 2-127 days. The falls(28 cases; 53.8%) and automobile accidents(8 cases; 65.3%)were the main causes of injury. The C4-5 and C1-3 were most common injury levels for 33(63.5%)and 11(21.2%), respectively.The complete injury(class A) and incomplete injury(grade B, C, D) were 28 cases(53.8%) and 24 cases(46.2%), respectively.Two hundred forty two cases(17.7%) were cervical spinal cord injury without respiratory failure. Among them,198 cases were male patients(81.8%) and 44 cases were female patients(18.2%), the average age were 48.1±14.7 years old.The average hospital stay days were 22.7±18.9, ranged from 1-128 days. The falls(86 cases;35.5%) and automobile accidents(66 cases; 27.3%)were the main causes of injury. The C4-5 and C6-8 were most common levels injury 162(66.9%) and 63(26.0%), respectively. The complete injury(class A) and incomplete injury(grade B, C, D) were 19 cases(7.9%) and 223 cases(92.1%), respectively.Comparing the group with respiratory failure with the group without respiratory failure, the difference were significant(P<0.05)in smoking, cause of injure, level of cervical spinal cord, ASIA degree and dislocation after fracture. The multivariate Logistic Regression analysis of the group with respiratory failure, the difference were significant(P<0.10)in over 60 years old age, smoking history, multiple trauma, dislocation after fracture, injury site higher than C4 level and complete paralysis.Conclusions1. Smoking, cause of injury, level of injury, ASIA grade, dislocation after fracture were the independent risk factors for respiratory failure.2. Over 60 years old age, smoking history, multiple trauma, dislocation after fracture, injury site higher than C4 level and complete paralysis were the higher risk factors for respiratory failure.