경추손상후 사망원인과 심폐기능 = Causes of Death and Cardiopulmonary Function in Cervical Spine Injury

다국어 초록 (Multilingual Abstract)

Mortality after cervical spine injury is reported as high as 15∼30%, and it is intimately related to the initial cardiopulmonary function. We analysed the cause of death and initial cardiopulmonary function in 30 patients who expired at the Soonchunhyang University Chonnam Hospital after cervical spine injury between 1986 and 1993. Overall 42 patients(20.5%) expired in 205 patients with cervical spine injuries. Except 12 cases with concomitant fatal head injury and/or multiple systemic injuries, the mortality rate of cervical spine injury was 15.5%. It was 28.9% in cases with cord injury, and 2.1% in cases without cord injury.
Male to female ratio was 5 : 1. Fifth to seventh decades constituted 63.3%. Common causes of spinal injury were in-car accident(46.7%) and fall/slip(36.7%). The level of spinal injury was above C5(upper cervical group ; UCG) in 60%, and below C4(lower cervical group ; LCG) in 40%. Most of them(83.3%) expired within four weeks after the injury. Early death(within 7 days) was more common in the UCG(55.6%) than the LCG(25.0%). Associated injuries were found in 66.7%, and the head injury was the most common one. The injury severity score was over 25 in 93.3%, The higher the score, the earlier the patients expired(Fisher's test, P<0.05).
On arrival, hypotenstion(systolic blood pressure below 70㎜Hg), bradycardia(less than 60/min), and respiratory arrest was found in 23.3%, 26.7%, and 16.7%, respectively. The episode of bradycardia was found in 56.7%. It was more common in cases of the early death(69.2%) than those of the late death(47.1%). Hypoxia, hypercarbia, and acidosis was observed in 19.2%, 7.7% and 5.38%, respectively.
Respiratory failure was responsible for the majority(86.7%) of death. In UCG and cases of the early death, primary respiratory dysfunction was the main cause of death, while in LCG and cases of the late death, pulmonary complication was the major reason(Fisher's test, P<0.01, respectively).