中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (18): 2902-2907.doi: 10.3969/j.issn.2095-4344.3825

• 骨与关节综述 bone and joint review • 上一篇    下一篇

呼吸道管理及纤维支气管镜治疗创伤性颈脊髓损伤的价值

任炳开1，2，郑怡彬1，2，黄磊文1，2，吴繁辉1，2，杨  东1，2   

  1. 1南昌大学江西医学院，江西省南昌市   330000；2南昌大学第一附属医院骨科，江西省南昌市   330000
  • 收稿日期:2020-02-28 修回日期:2020-03-06 接受日期:2020-08-26 出版日期:2021-06-28 发布日期:2021-01-12
  • 通讯作者: 杨东，主任医师，硕士生导师，南昌大学江西医学院，江西省南昌市 330000；南昌大学第一附属医院骨科，江西省南昌市 330000 郑怡彬，在读硕士，南昌大学江西医学院，江西省南昌市 330000；南昌大学第一附属医院骨科，江西省南昌市 330000
  • 作者简介:任炳开，男，1995年生，江西省上饶市人，汉族，南昌大学江西医学院在读硕士，主要从事骨科颈脊髓损伤方面的研究。
  • 基金资助:
    国家自然科学基金地区项目(81672139)，项目负责人：杨东；江西省研究生创新专项(YC2019-S110)，项目负责人：郑怡彬

Value of respiratory tract management and fiberoptic bronchoscopy in traumatic cervical spinal cord injury

Ren Bingkai1, 2, Zheng Yibin1, 2, Huang Leiwen1, 2, Wu Fanhui1, 2, Yang Dong1, 2    

  1. 1Jiangxi Medical College of Nanchang University, Nanchang 330000, Jiangxi Province, China; 2Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China
  • Received:2020-02-28 Revised:2020-03-06 Accepted:2020-08-26 Online:2021-06-28 Published:2021-01-12
  • Contact: Yang Dong, Chief physician, Master’s supervisor, Jiangxi Medical College of Nanchang University, Nanchang 330000, Jiangxi Province, China; Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China Zheng Yibin, Master candidate, Jiangxi Medical College of Nanchang University, Nanchang 330000, Jiangxi Province, China; Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China
  • About author:Ren Bingkai, Master candidate, Jiangxi Medical College of Nanchang University, Nanchang 330000, Jiangxi Province, China; Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China
  • Supported by:
    the National Natural Science Foundation of China (Regional Program), No. 81672139 (to YD); Jiangxi Postgraduate Innovation Project, No. YC2019-S110 (to ZYB)

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摘要：

文题释义：
颈脊髓损伤：是一种非常严重的损伤，常造成患者残疾或死亡。颈上段脊髓损伤者易发生四肢瘫痪，如果膈肌和肋间肌瘫痪，可发生呼吸困难，常致患者迅速死亡。颈下段脊髓损伤者在损伤平面以下出现肢体瘫痪，上肢呈节段性感觉和运动障碍；由于胸部呼吸肌瘫痪，患者仅有腹式呼吸，同时伴有括约肌功能障碍和Horner综合征。脊髓完全断裂者可立即发生弛缓性完全瘫痪，损伤平面以下各种感觉和反射消失，一般不能恢复。
纤维支气管镜(纤支镜)：发明后已广泛应用于临床，除在呼吸系统疾病诊断方面取得很大进展之外，在治疗方面也得到广泛应用，如慢性呼吸衰竭患者呼吸道、肺部感染未控制者，由于多量分泌物阻塞气道使病情加重，加上患者咳嗽无力，从鼻或口腔吸痰不能达到彻底清除分泌物目的，可使用纤维支气管镜直视下把气道分泌物抽吸干净。

背景：颈脊髓损伤患者早期就会出现严重的并发症，以呼吸系统并发症最为常见，因此颈脊髓损伤患者呼吸道管理对患者的康复尤为重要。
目的：介绍颈脊髓损伤患者损伤后神经解剖及病理特点，总结近年来国内外颈脊髓损伤患者呼吸道并发症多重治疗方法及纤维支气管镜治疗的应用情况。
方法：通过输入“颈脊髓损伤，肺部感染，呼吸道管理，抗生素，神经移位术，气管切开，机械通气，纤维支气管镜，肺炎，cervical spinal cord injury，fibrobronchoscopy，bronchoalveolar lavage ，tracheotomy，pneumonia”等检索词，利用计算机检索中国期刊全文数据库(CNKI)、万方、SinoMed、PubMed和Web of Science数据库，查阅近年纤维支气管镜在颈脊髓损伤方面应用的相关文献，通过阅读标题及摘要进行初步筛选，排除与主题相关度低的文献，最终共纳入57篇文献进行综述。
结果与结论：①目前颈脊髓损伤患者呼吸道并发症治疗策略包括：患者仰卧位及使用腹带、呼吸训练、机械性辅助咳嗽、机械通气、气管切开术、膈肌起搏器、神经移位技术、纤维支气管镜吸痰及肺泡灌洗、使用抗生素等；②目前早期气管切开、无创通气和辅助咳嗽技术对高位脊髓损伤患者的积极治疗效果已渐渐被学术界认可，其能改善患者呼吸功能，而体位、呼吸训练、辅助咳嗽已广泛联合运用于临床上，得到满意效果；③近些年纤维支气管镜吸痰及肺泡灌洗已广泛运用于治疗肺部感染患者，具有良好的治疗效果；对于伴有呼吸道并发症的颈脊髓损伤患者，应用纤维支气管镜吸痰及肺泡灌洗治疗同样能缓解患者的呼吸困难，改善肺功能，可能会成为颈脊髓损伤患者诊疗的新方向。

关键词: 颈脊髓损伤, 呼吸道管理, 肺部感染, 气管切开, 机械通气, 神经移位术, 纤维支气管镜, 肺泡灌洗, 综述

Abstract: BACKGROUND: Patients with cervical spinal cord injury will have serious complications in the early stage, of which respiratory complications are the most common. Therefore, respiratory tract management is particularly important for the rehabilitation of patients with cervical spinal cord injury.
OBJECTIVE: To introduce the neuroanatomical and pathological features of cervical spinal cord injury, and to summarize the multiple treatments of respiratory complications in patients with cervical spinal cord injury and the application of fiberoptic bronchoscopy in patients with cervical spinal cord injury in recent years.
METHODS: By inputting the key words of “cervical spinal cord injury, pulmonary infection, respiratory tract management, antibiotics, nerve transfer, tracheotomy, mechanical ventilation, fiberoptic bronchoscope, pneumonia” in Chinese and “cervical spinal cord injury, fibrobronchoscopy, bronchoalveolar lavage, tracheotomy, pneumonia” in English, we searched the CNKI, Wanfang, SinoMed, PubMed, and Web of Science for the related literature on the application of fiberoptic bronchoscopy in spinal cord injury in recent years. Through the preliminary screening of reading titles and abstracts, the articles with low relevance to the topic were excluded, and a total of 57 articles were included for review. 
RESULTS AND CONCLUSION: (1) At present, the treatment strategies of respiratory complications in patients with cervical spinal cord injury include supine position and use of abdominal band, respiratory training, mechanically assisted cough, mechanical ventilation, tracheotomy, diaphragm pacemaker, nerve transfer technique, fibrobronchoscopic sputum suction and bronchoalveolar lavage, and antibiotics use. (2) At present, the positive effects of early tracheotomy, non-invasive ventilation and auxiliary cough on patients with high spinal cord injury have been gradually recognized by the academic circles, which can improve the respiratory function of patients, while posture, respiratory training, and auxiliary cough have been widely used in clinical practice and achieved satisfactory results. (3) In recent years, bronchofiberscope suction and bronchoalveolar lavage have been widely used in the treatment of patients with pulmonary infection, and have a good therapeutic effect. For patients with cervical spinal cord injury with respiratory complications, fiberoptic bronchoscopy and bronchoalveolar lavage can also improve dyspnea and pulmonary function, which may become a new direction of diagnosis and treatment of cervical spinal cord injury patients.

Key words: cervical spinal cord injury, respiratory management, pulmonary infection, tracheotomy, mechanical ventilation, nerve transfer, fiberoptic bronchoscope, bronchoalveolar lavage, review

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