Analysis Of Death-related Factors Of Severe Traumatic High Paraplegia Of Cervical Spinal Injury

Objective:To analyze the death--related factors of severe traumatic high paraplegia of cervical spinal cord injury,and improve the treatment of high cervical paraplegia patients.Methods:The clinical data of 48 patients with severe traumatic high paraplegia of cervical spinal cord injury(ASIA grade:A or B)treated at the 904 Hospital of PLA from March 2012 to August 2018 were analyzed retrospectively.In these patients,13 patients were died according to the follow up at 6 month,the other 35 patients were living.The following data were recorded:sex age,the causes of injury,injury segment and degree,combined injury,underlying disease,operation rate at different time(less than 48h or more than 48h),tracheotomy rate,whether hyponatremia,diabetes insipidus,hyperpyrexia rate,respiratory failure rate,hypotension rate,respiratory infection rate,and intestinal paralysis rate.Results:The main cause of injury for the two groups was falling from a high place and traffic injury.Univariate analysis showed that significant differences were detected between the death group and the no-death group with regard to age[(61.15 ±10.74)y vs.(49.71 ± 13.84)y],ASIA grade A rate(76.9%vs.37.1%),tracheotomy rate(92.3%vs.54.3%),respiratory failure rate(92.3%vs.31.4%),hypotension rate(84.6%%.34.3%)and intestinal paralysis(92.3%vs.42.9%),(P<0.05)while there was no significant differences between two groups in the ratio of males(84.6%vs.88.6%),the upper cervical injury segment(76.9%vs.57.1%),combined injury(30.8%vs.42.9%),hypertension rate(30.8%vs.14.3%),previous diabetes(15.4%vs.11.4%),less than 48h operation(38.5%vs.38.1%),hyponatremia(46.2%vs.51.4%),diabetes insipidus(76.9%vs.48.6%),hyperpyrexia(84.6%vs.82.9%),respiratory infection(92.3%vs.60%),(P>0.05).Multivariate logistic regression analysis showed that the older age(OR=1.358,95%CI:1.269～11.921,P=0.017),ASIA grade A(OR=-2.950,95%CI:0.004～0.763,P=0.031),respiratory failure(OR=3.807,95%CI:3.131～647.209,P=0.005)were independent risk factors associated with death.Conclusions:The incidence of various systemic complications in patients with severe traumatic cervical high paraplegia is high.The older patient,when suffering complete spinal cord injury and respiratory failure,is alert to the risk of death.