急性颈脊髓损伤发热原因识别及处理.pdfVIP

·418 · 临床骨科杂志　 Journal of Clinical Orthopaedics　 2015 Aug;18(4) doi:10.3969/ j.issn.1008-0287.2015.04.011 ·临床论著 · 急性颈脊髓损伤发热原因识别及处理 赖必华,吴建斌,高招文,连伟飞 摘要:目的　 探讨急性颈脊髓损伤发热原因的诊断和治疗策略。 方法　 对38例急性颈脊髓损伤伴发热患者 (术后吸收热除外) 的临床资料进行回顾性研究,分析发热原因、发热持续时间,明确诊断所需时间、处理措施 及临床转归情况。 结果　 急性颈脊髓损伤发热原因:肺部感染16例,植物神经功能紊乱7例,尿路感染5例, 胸腔积液3例,切口感染2例,食管瘘、鼻窦炎、压疮伴感染、上消化道穿孔及下肢深静脉血栓各1例。 鼻窦炎 所致发热持续时间及明确诊断所需时间最长,分别为11 d及9 d,压疮伴感染所致发热持续时间及明确诊断 时间最短,分别为2 d及1d。 5例死亡发热患者中,3例为肺部感染,1例为上消化道穿孔,1例为植物神经功 能紊乱。 其余患者给予相应处理后体温均正常。 结论　 急性颈脊髓损伤发热常见原因有肺部感染、植物神经 功能紊乱及尿路感染,应警惕发热可能掩盖的致死性疾病,明确诊断后给予针对病因治疗。 关键词:发热;急性颈脊髓损伤;肺部感染;尿路感染;植物神经功能紊乱 中图分类号:R683.2;R653.1　 文献标识码:A　 文章编号:1008-0287(2015)04-0418-04 Determination and treatment for fever origin in acute cervical spinal cord injury　 LAI Bi- hua,WUJian-bin,GAOZhao-wen,LIAN Wei-fei　 (Section Ⅱ,Deptof Orthopaedics,theFirstHos- pital of Nanping City Affiliated to FujianMedical University,Nanping,Fujian　 353001,China) Abstract:Objective　 To explore the causeoffever inacutecervical spinal cordinjury (ACSCI)patientsandclini- cal treatment. Methods　 38 cases of clinical data of acute cervical spinal cord injury patients with fever were re- viewed.The cause offever,durationoffeverwasanalyzedandrecorded,thetimefordiagnosis,thetreatmentandclini- cal outcomes of fever wasrequired. Results　 The causes of fever in ACSCI included 16 cases of pneumonia,7 cases of autonomic dysfunction,5 casesof urinary tract infections,3 casesof pleural effusionin,2 casesincision infection,e- sophageal fistulathe,sinusitis,pressure ulcerswith infection,upper gastrointestinal perforation and deepveinthrom- bosis in 1case.Thelongestdurationoffeverandtimerequiredfordiagnosiswerefeverresultedfromsinusitiswithre- spectively 11days and9 days. The shortest werefever causedfrom decubituswith infection with respectively 2 days and 1day. Therewere5 patients died among whom3 patientswith pneumonia,1with upper gastrointestinal perfora