摘要
目的分析收治于重症监护室的高-中颈段脊髓血管畸形患者的临床特点。方法回顾性连续纳入首都医科大学宣武医院神经外科监护室2016年1月至2020年12月收治的符合入排标准的高-中颈段(枕骨大孔区至颈椎C5节段)脊髓血管畸形患者共18例。收集一般资料及脊髓血管畸形相关资料,一般资料包括年龄、性别、体质量指数、临床症状以及基础疾病(高血压病、糖尿病、冠心病);脊髓血管畸形相关资料包括主要诊断、畸形团和(或)瘘口所在颈椎节段、畸形团在髓内的位置、是否首诊、手术时长、治疗方式、治疗后病变闭塞程度、入监护室后首次动脉血二氧化碳分压、是否出现重症颈段脊髓血管畸形的临床表现、相关的并发症(脑积水、新发脑梗死等)。重症颈段脊髓血管畸形为出现以下至少一项临床表现,即意识障碍、呼吸困难、吞咽反射减弱、呛咳反射减弱、蛛网膜下腔出血。终点事件为住院时长、监护室时长。根据入住监护室时长是否达24 h分为≥24 h组和<24 h组,以中位住院时长为住院时长的分组界限,分别进行组间单因素分析。结果18例患者中有8例符合重症颈段脊髓血管畸形的特点,中位住院时长11.00(6.75,16.25)d,故将住院时长分为<11 d组和≥11 d组。与住院时长≥11 d组比较,<11 d组在一般资料及脊髓血管畸形相关资料的差异均无统计学意义(均P>0.05)。与入住监护室时长≥24 h组比较,<24 h组的患者中病变性质为非动静脉畸形病变的占比较高,组间差异有统计学意义(P<0.05),其余一般资料及脊髓血管畸形相关资料的差异均无统计学意义(均P>0.05或P=0.05)。结论C1~C5节段脊髓血管畸形由于部位特殊,可能出现意识障碍、呼吸功能障碍、呛咳反射减弱等需要重症监护治疗的临床表现。脊髓血管畸形属于临床少见病,本研究结果尚需纳入更多的样本量或多中心数据进一步验证。
Objective To analyze the clinical characteristics of patients with high-mid cervical spinal vascular malformation admitted in neurosurgical intensive care unit(NICU).Methods A total of 18 patients with high-mid cervical spinal vascular malformation(from foramen magnum to C5)and admitted to the NICU of Xuanwu Hospital,Capital Medical University from January 2016 to December 2020 were retrospectively included.General information and spinal vascular malformations data were collected.General information included age,gender,body mass index(BMI),clinical manifestations and cardiovascular underlying diseases(hypertension,diabetes,coronary heart disease).Spinal vascular malformation data included main diagnosis,the cervical spine segment of malformation and/or fistula,the intramedullary position of nidus,whether the malformation was first diagnosed,operation time,treatment method,obliteration or not after treatment,the first PaCO_(2) after admission to the NICU,with the clinical manifestations of severe cervical spinal vascular malformation or not,and related complications(hydrocephalus,new cerebral infarction,etc.).Severe cervical spinal vascular malformation was characterized by at least one of the following clinical manifestations,namely,disturbance of consciousness,dyspnea,reduced swallowing reflex,reduced coughing reflex,and subarachnoid hemorrhage.The primary endpoint was length of hospitalization and length of NICU.The NICU duration was divided into<24 h group and≥24 h group;the length of hospital stay was divided into two groups according to the median.Univariate analysis was performed between groups.Results The 8 out of 18 patients were found to have clinical manifestations of severe cervical spinal vascular malformation.The median length of hospitalization was 11.00(6.75,16.25)d,so the length of hospitalization was divided into<11 d group and≥11 d group.Compared with the≥11 d group,the<11 d group had no statistical significance in the aforementioned general information and spinal vascular malformations data(all P>0.05).Compared with the group whose duration of stay in NICU≥24 h,patients in<24 h group had a higher proportion of lesions with non-arteriovenous malformations,and the difference between two groups was statistically significant(P<0.05).There were no significant differences in other general information and spinal cord vascular malformation data(all P>0.05 or P=0.05).Conclusions Due to the special location,spinal cord vascular malformations at C1-C5 may be manifested with disturbance of consciousness,respiratory dysfunction,reduced cough reflex and other clinical manifestations requiring intensive care treatment.Spinal vascular malformation is a rare clinical disease,and the results of this study need to be further verified by incorporating more sample sizes or multi-center data.
作者
蒋丽丹
齐猛
于嘉兴
马永杰
陈文劲
徐跃峤
程玮涛
曲鑫
张鸿祺
王宁
Jiang Lidan;Qi Meng;Yu Jiaxing;Ma Yongjie;Chen Wenjin;Xu Yueqiao;Cheng Weitao;Qu Xin;Zhang Hongqi;Wang Ning(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2022年第7期476-483,共8页
Chinese Journal of Cerebrovascular Diseases
基金
北京市科技计划项目(D161100003816001)。
关键词
血管畸形
颈段
脊髓血管畸形
危重病人医疗
Vascular malformations
Cervical
Spinal vascular malformation
Critical care
