急性颈脊髓损伤早期神经功能检查时机与神经功能预后的关系  

Timing of nervous system examination within a few hours after acute traumatic spinalcord injury

作　　者：郑志刚 陈兰涛 段宝民 ZHENG Zhi-gang;CHEN Lan-tao;DUAN Bao-min(Emergency Department of Kaifeng City Central Hospital,kaifeng,henan475100,China)

机构地区：[1]开封市中心医院急诊科,河南开封475100

出　　处：《颈腰痛杂志》2022年第6期853-856,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的 探讨急性创伤性颈脊髓损伤后短时间内神经系统检查时间差异与患者神经功能恢复的关系。方法 选择2016年1月~2019年12月在本院就诊的91例ASIA分级为A级的急性创伤性颈脊髓损伤患者,入院后予以固定颈椎、减轻脊髓水肿、营养神经等对症治疗,根据患者神经系统检查时间分为0~4 h组、>4~8 h组、>8~12 h组、>12~24 h组和>24~48 h组,观察各组患者治疗前后的ASIA分级和国际脊髓损伤神经分类标准(ISNCSCI)的分级变化情况,采用多因素分析验证神经系统检查时间对ASIA变化的影响。结果 有52.75%的患者获得ASIA≥1级功能改善,其中0~4 h行神经功能检查者为83.33%,高于>4~8 h(52.17%)、>8~12 h(42.11%)、>12~24 h(38.89%)和>24~48 h(46.15%)神经功能检查的患者(P<0.05)。55.56%的0~4 h行神经功能检查患者ASIA分级改善≥2个等级,高于>4~8 h、>8~12 h、>12~24 h和>24~48 h患者。多因素Logistic回归分析显示,首次神经系统检查时间<4 h与ASIA分级改善相关(OR=5.034,95%CI=1.137~10.672,P=0.036)。0~4 h、>4~8 h患者的ISNCSCI变化更大,但两组患者治疗前后的ISNCSCI变化差异无统计学意义(P>0.05)。结论 ATSCI患者损伤后短期内神经系统检查时间的变化,可能影响长期功能恢复结果,ASIA评估完全性损伤的ATSCI患者在≤4 h行神经学评估,可获得更好的ASIA分级恢复效果;但神经系统检查时间变化对运动功能评分的影响仍不确定。Objective To investigate the relationship between the time difference of nervous system examination and the recovery of neurological function in patients with acute traumatic cervical spinal cord injury. Methods 91 patients with ASIA grade A acute traumatic cervical spinal cord injury who were treated in our hospital from January 2016 to December 2019 were selected as the research objects. They were divided into 0-4 h group, >4-8 h group, >8-12 h group, >12-24 h group and >24-48 h group according to the time of neurological examination. The changes of American Spinal Cord Injury Association(ASIA) scale and international neurological classification of spinal cord injury(ISNCSCI) were observed. The influence of neurological examination time on the changes of ASIA was analyzed by multivariate analysis. Results 52.75% of the patients had ASIA≥1 grade functional improvement, of which 83.33% had neurological function examination in 0-4 h, which was higher than those in >4-8 h(52.17%), >8-12 h(42.11%), >12-24 h(38.89%) and >24-48 h(46.15%)(P<0.05). 55.56% of the patients who underwent neurological function examination at 0-4 h had more than 2 levels of ASIA improvement, which was higher than those who were >4-8 h, >8-12 h, >12-24 h and >24-48 h. Multivariate logistic analysis showed that baseline neurological examination time <4 h was associated with improvement of ASIA(OR=5.034,95%CI=1.137-10.672,P=0.036).However, there was no significant difference in the changes of ISNCSCI among the patients with neurological examination time(P>0.05). Conclusion Changes of neurological examination time in patients with acute traumatic spinal cord injury in the short term after injury may affect the long-term functional recovery results. Neurological assessment in patients with atsci with complete injury assessed by ASIA within ≤4 h can obtain better ASIA grading recovery effect. However, the impact of neurological examination time on motor function score is still uncertain.

关 键 词：急性创伤性脊髓损伤 神经系统检查 时机 美国脊髓损伤协会分级 

分 类 号：R826.64[医药卫生—临床医学]