276例严重颈脊髓创伤合并四肢瘫患者的术后生存分析  

Postoperative survival analysis of 276 cases of severe cervical spinal cord injury with tetraplegia

作　　者：杨意鹏 张扬 黄鑫怡 邱海洋 刘大铭 吴子祥 雷伟 YANG Yipeng;ZHANG Yang;HUANG Xinyi;QIU Haiyang;LIU Daming;WU Zixiang;LEI Wei(Department of Orthopedics,the First Affiliated Hospital of Air Force Medical University,Xi'an 710032,Shaanxi,China)

机构地区：[1]空军军医大学第一附属医院骨科,西安710032

出　　处：《医学研究与战创伤救治》2024年第6期610-615,共6页Journal of Medical Research & Combat Trauma Care

摘　　要：目的 分析颈髓创伤所致四肢瘫患者(ASIA分级A级或B级)术后的累计生存率和死亡风险因素,并建立Cox比例风险回归模型筛选影响生存时间和结局的协变量。方法 回顾性分析2010年1月1日至2022年6月30日在空军军医大学第一附属医院住院并接受手术治疗的创伤性颈段脊髓损伤致四肢瘫患者(ASIA分级A和B级)的临床资料。利用乘积极限法(Kaplan-Meier)估计患者生存率并绘制生存曲线,单一分组变量组间生存率的比较采用log-rank检验。利用Cox比例风险回归模型进行单因素和多因素生存分析。结果 根据纳入排除标准共纳入276例患者,其1年、5年和10年的生存率分别为79.92%、71.77%和65.07%,死亡患者的平均生存时间为(560.88±94.23)d,中位生存时间为198 d(Q1,25;Q3,688)。单因素Cox分析结果表明,高龄(>50岁)、患有高血压/糖尿病等基础疾病、ICU维持>72 h、肺部感染、呼吸衰竭及消化道出血是患者的死亡风险因素。此外,在手术入路这一变量的亚组间分析中,前路手术患者的生存率显著高于后路手术(P=0.017)。多因素Cox比例风险回归模型分析显示,高龄(>50岁)、患有高血压/糖尿病等基础疾病、肺部感染及呼吸衰竭是影响患者生存的独立风险因素。结论 临床上应高度关注高龄CSCI四肢瘫患者,对患者术后早期肺部感染及呼吸衰竭等并发症的管理亦应尤为小心。高血压、糖尿病等基础疾病可能会影响患者的康复进程与预后。Objective This study is aimed to analyze the cumulative survival rate and identify risk factors associated with mortality in a cohort of 276 patients with tetraplegia resulting from cervical spinal cord injury(classified as ASIA grades A or B)fol-lowing surgical intervention and to identify significant covariates that impact survival time and overall outcomes.Methods A retro-spective analysis was conducted on the clinical data of patients with traumatic cervical spinal cord injury resulting in tetraplegia(ASIA grades A and B)who were hospitalized and underwent surgical treatment at our hospital from January 1,2010 to June 30,2022.The survival rates of these patients were estimated using the Kaplan-Meier method.The log-rank test was utilized for the comparison of sur-vival rates between different subgroups based on single grouping variables.Furthermore,univariate and multivariate survival analysis were performed using the Cox proportional hazards regression model.Results A total of 276 patients were included in the study based on the inclusion and exclusion criteria.The 1-year,5-year,and 10-year survival rates were 79.92%,71.77%,and 65.07%,re-spectively.The mean survival time for deceased patients was 560.88±94.23 days,with a median survival time of 198 days(Q1,25;Q3,688).Univariate Cox analysis revealed that advanced age(>50 years),presence of underlying conditions such as hypertension or dia-betes,ICU stay>72 hours,pulmonary infection,respiratory failure,and gastrointestinal bleeding were risk factors for patient mortality.Within the surgical approach variable,the survival rate was signifi-cantly higher for anterior surgery compared to posterior surgery(P=0.017).Multivariate Cox proportional hazards regression model analysis showed that advanced age(>50 years),presence of underlying conditions such as hypertension or diabetes,pulmonary infec-tion,and respiratory failure were independent risk factors for patient survival.Conclusion High attention should be paid to elderly CSCI patients with tetraplegia,and speci

关 键 词：脊髓损伤 四肢瘫 生存分析 颈椎外伤 

分 类 号：R744[医药卫生—神经病学与精神病学]