경추손상후 발생된 호흡기 합병증에 관한 연구

Background: The cervical injuries may impose a fatal result or permanent neurologic damage with multiple severe complications. Moreover most early deaths following acute cervical injury are due to pulmonary complications in spite of recent improvements in respiratory management. Objectives: With a comprehensive evaluation of pulmonary complications, the cervical injured patients with pulmonary dysfunction have a proper opportunity to be treated. Therefore it is important to know the incidence and the sorts of pulmonary complications in patients with cervical cord injury and to assess the important factors affecting on the development of pulmonary complications after cervical cord injury. Methods: The authors reviwed 84 patients who had visited Chung-Ang University Hospital due to cervical injury from 1988 to 1933. And the clinical data were analyzed according to the etiology of injury, injury level, presence or absence of pulmonary complications, neurologic status of the patients, associated trauma and multiple cervical fractures. Results: 1) The pulmonary complications occurred in 25 (28.6%) of the 84 patients with cervical injury. 2) The most common pulmonary complication was pneumonia (59.4%). Atielectasis and acute respiratory failure occurred in 5 patients respectively (15.6%). 3) Without complete neurolgic deficit, the development of pulmonary complications was primarily not dependent on the level of cervical cord injury. 4) The inportant factors affecting on the development of pulmonary complications were as follows Age over 50 years, initial neurologic status above grade C on Frankel classification, previous pulmonary diseases, associated trauma or head trauma and multiple cervical fractures. 5) There was significant difference in the patient distribution between the survivors (31.2%) and the non-survivors (62.5%) among the patients with pulmonary complications whose initial neurologic status was grade A. 6) The most common cause of death was pneumonia Conclusion: In patients with cervical cord injury the incidenc rate of pulmonary complication would be increased in patients with poor neurologic status, old age, previos underlying pulmonary diseases, associated trauma and multiple cervical fractures. Therefore in these patients, especially with pneumonia, intensive respiratory management is required.