应用骶残留自评问卷估测美国脊柱损伤协会脊髓损伤分级的效度研究  

Validation of estimating American Spinal Injury Association Impairment Scale grade with a self-administered questionnaire for assessment of sacral sparing after spinal cord injury

作　　者：邢华医[1] 刘楠[1] 周谋望[1] XING Huayi;LIU Nan;ZHOU Mouwang(Department of Rehabilitation Medicine,Peking University Third Hospital,Beijing 100191,P.R.China)

机构地区：[1]北京大学第三医院康复医学科,北京100191

出　　处：《华西医学》2020年第5期538-543,共6页West China Medical Journal

基　　金：国家自然科学基金(81871851)。

摘　　要：目的探索一种基于肠道日常管理的脊髓损伤骶残留自评问卷对估测美国脊柱损伤协会脊髓损伤分级(American Spinal Injury Association Impairment Scale,AIS)的效度。方法选择2014年8月-2016年7月住院治疗的脊髓损伤患者为研究对象,使其完成包含5项问题的骶残留自评问卷并接受标准的肛门直肠体格检查。问卷中问题1(感知手纸)、问题2(辨别水温)、问题3(感知插入直肠的手指)及问题4(感知插入直肠的灌肠剂容器前端)用于估测感觉骶残留,问题5(憋住灌肠剂超过1 min)用于估测运动骶残留。根据研究对象的问卷答案估测骶残留及AIS分级(根据问卷结果可以估测AIS分级为A、B、C/D)。分析问卷估测与体格检查发现的AIS分级的一致性,并计算问卷估测AIS分级的灵敏度、特异度及Youden指数。结果共纳入102例患者。问卷估测与体格检查发现的AIS分级整体一致性良好(κ=0.681,P<0.001);对完全性损伤的估测灵敏度(87.10%)和特异度(100.00%)较高,Youden指数为0.87;对运动完全性损伤的估测灵敏度升高(92.00%)而特异度(75.00%)略降低,Youden指数为0.67。结论基于肠道日常管理的自评问卷对估测AIS分级的效度良好,对于AIS分级的估测具有较好的准确性,可在无法进行肛门直肠检查的情况下作为补充和替代工具。Objective To investigate the validity of estimating American Spinal Injury Association Impairment Scale(AIS) grade with a bowel-routine based self-administered questionnaire for assessment of sacral sparing after spinal cord injury(SCI). Methods The 5-item SCI sacral sparing self-report questionnaire was administrated to SCI inpatients from August 2014 to July 2016, followed by an standardized digital rectal examination. Question 1(perceiving the tissue), Question 2(identifying the water temperature as warm or cold), Question 3(perceiving the inserted finger), and Question 4(perceiving the inserted enema tube) tested the sensory sacral sparing, and Question 5(holding the enema for more than 1 min) evaluated the voluntary anal sphincter contraction. Based on the answers from each participant, the sensory and motor sacral sparing was implied, and an estimated AIS grade(AIS A, AIS B, or AIS C/D) was recorded. Agreement of the estimated AIS grade and the actual AIS grade according to the physical examination was analyzed. Sensitivity, specificity, and Youden’s index of the questionnaire for estimating completeness of injury were calculated. Results A total of 102 SCI patients were enrolled. The general agreement of estimated and actual AIS grades was good(κ=0.681, P<0.001). For the estimation of a complete injury, both the sensitivity(87.10%)and the specificity(100.00%) of this questionnaire were high, with a Youden’s index of 0.87. For the estimation of a motor complete injury, the sensitivity increased(92.00%) while the specificity decreased slightly(75.00%), with a Youden’s index of 0.67. Conclusions The validity of this self-report questionnaire for estimation of AIS grade is good. In some situations, it could be considered as an alternative tool for the estimation of sacral sparing as well as the AIS grades within SCI individuals, especially when repeated anorectal examinations are not feasible.

关 键 词：脊髓损伤 骶残留 自评问卷 效度 

分 类 号：R651.2[医药卫生—外科学]