成年脊髓损伤患者功能结局的预测模型研究  

Predictive Model for Functional Outcome of Adult Spinal Cord Injury

作　　者：崔尧[1,2] 丛芳[1,2] 李建军[1,2,3] 高峰 杜良杰[1,2] 杨明亮[1,2] CUI Yao;CONG Fang;LI Jian-jun;GAO Feng;DU Liang-jie;YANG Ming-liang(Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China;Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China;Chinese Institute of Rehabilitation Science,Beijing 100068,China)

机构地区：[1]首都医科大学康复医学院,北京市100068 [2]中国康复研究中心北京博爱医院,北京市100068 [3]中国康复科学所,北京市100068

出　　处：《中国康复理论与实践》2019年第10期1125-1132,共8页Chinese Journal of Rehabilitation Theory and Practice

基　　金：中国康复研究中心科研基金项目(No.2016ZX-01);财政部中央国家单位科研项目基金项目(No.2014CZ-2);北京市科技计划重大项目课题(No.D161100002816004);首都卫生发展科研专项项目(No.首发2018-1-6011)~~

摘　　要：目的探索影响成年脊髓损伤患者功能结局的相关因素并构建预测模型。方法对2016年9月至2018年12月110例成年脊髓损伤截瘫住院患者的病历资料进行回顾性分析,系统收集可能影响功能预后的量化指标,包括年龄,住院天数,其他诊断数量,并发症数量,合并症数量,手术次数,发病到康复治疗介入的天数,出院和入院时的脊髓损伤神经学分类国际标准下肢运动总分(LEMS)、轻触觉(LT)总分、针刺觉(PP)总分以及改良Barthel指数(MBI),计算出入院MBI总分(MBI入院)的变化值及入院变换率,进行各变量间的单因素相关性分析,并对影响出院MBI总分(MBI出院)及出入院MBI总分变化值出院(MBI变化)的因素进行多元线性回归建模。结果MBI出院与MBI入院、入院LEMS(LEMS入院)、入院PP总分、入院LT总分、发病到康复治疗介入的天数、手出院入院入院术次数和合并症数量共7个变量显著相关;最优回归方程:MBI出院=28.24+0.52×MBI入院+0.24×LEMS入院-1.23×合并症数量(R2=0.64,P<0.001)。MBI变化与MBI入院、发病到康复治疗介入的天数和住变化入院院天数3个变量显著相关;最优回归方程:MBI变化=18.44-0.29×MBI+0.06×住院天数(R2=0.29,入院P<0.001)。结论脊髓损伤患者入院时功能状态好,运动评分高,合并症少,住院时间长,则预期功能恢复良好。Objective To explore the related factors affecting the functional outcome of adult spinal cord injury and to establish a predictive model.Methods A retrospective analysis was made on the medical records of 110 adult spinal cord injured patients with paraplegia from September,2016 to December,2018.Quantitative indicators that affected functional outcome were systematically collected,including age,length of stay,number of other diagnostic,number of complications,number of comorbidities,number of operations,days from onset to rehabilitation intervention,and the total scores of Lower Extremity Motor Subscore(LEMS),light touch(LT),pin prick(PP)and modified Barthel Index(MBI)at admission(MBIa)and discharge(MBId),the change values and change rates of MBI were calculated.The correlation coefficients among variables were analyzed.Multivariate linear regression models were established for the MBI total score at discharge and change of MBI score from admission to discharge(MBIc).Results MBId was significantly correlated with MBIa,the total score of LEMS at admission(LEMSa),the total score of PP at admission,the total score of LT at admission,the number of days from onset to rehabilitation intervention,the number of operations and the number of comorbidities.The fitted regression equation was:MBId=28.24+0.52×MBIa+0.24×LEMSa-1.23×number of comorbidities(R2=0.64,P<0.001).The MBIc was significantly correlated with MBIa,the days from onset to rehabilitation intervention and the length of stay.The fitted regression equation was:MBIc=18.44-0.29×MBIa+0.06×length of stay(R2=0.29,P<0.001).Conclusion The spinal cord injured patients with better functional status,higher motor score and less comorbidity at admission,and longer hospitalization have better functional recovery.

关 键 词：脊髓损伤 截瘫 功能结局 预测模型 康复结局 

分 类 号：R651.2[医药卫生—外科学]