頸髓損傷患者於睡眠時猝死：兩病例報告

高位頸髓損傷患者由於掌管橫膈肌的頸髓第三至第五節受損，常造成呼吸功能的減弱，甚至睡眠中死亡。究其原因，可能為肺泡慢性通氣不足或氣道分泌物阻塞。睡眠時發生呼吸困難，常無明顯的臨床症狀，但此時大部分患者其肺活童已小於預測值之半。若封病人施行24小時之血中氣體監測，經常可以發現夜眠時二氧化碳滯留及血氧降低的現象。故若能以非侵襲性方法對高危險群患者早日偵測其異常而加以防範應可避免其猝死。本研究提出二例高位頸髓損傷患者夜眠猝死之案例，一為外傷性第四頸髓完全損傷，另一為鼻咽癌患者經放射線治療後引發第三頸髓不完全損傷。第一位患者於轉入本院當晚即於睡眠中死亡，故來不及進行肺功能測試，第二位患者雖知其肺功能持續衰退，血中氣體分析值仍然正常，但由於未進行24小時之血中氣體監測，而無法確知其夜眠時呼吸狀況惡化程度。由本研究經驗，作者建議：對於高位頸髓損傷患者皆應進行至少一次夜間睡眠之血中氣體監測。

關鍵字

夜眠猝死；脊髓損傷；夜眠監控；睡眠窒息

並列摘要

The high cervical cord injury patients,who have respiratory muscle dysfunction because of C3-C5 injury , may develop sudden death during sleep. It is commonly caused by chronic alveolar hypoventilation or air way mucus plugging. As it happens, there are usually rare remarkable clinical symptoms and signs. For individuals with spinal cord injury associated with less than 50% of predicted vital capacity, 24 hours' blood gas monitor always showed nocturnal hypoxemia as well as carbon dioxide retention. Early detection of these disorders is crucial to prevent these patients from sudden death. In this study, we proposed two cases of high cervical cord injury developing sudden death during sleep. One suffered from C4 complete traumatic cord injury, and the other was a C3 incomplete radiation myelopathy as a sequalae of radiotherapy for nasopharyngeal carcinoma. In the former, she died at the first night of her admission before we had performed the pulmonary function test for her. In the latter, deterioration of vital capacity was found, but 24 hours' blood gas monitor was not available and detection of nocturnal breathing disorder became impossible. The authors recommend 24 hours' blood gas monitor should be done routinely in high cervical cord injury individuals.to prevent the hazard of sudden death during sleep.

並列關鍵字

spinal cord injury ； sleep apnea ； sudden death ； nocturnal monitor

國際替代計量

頸髓損傷患者於睡眠時猝死：兩病例報告

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