[四肢瘫痪脊髓损伤患者首次入住康复中心后的生存率及预后因素：法国各中心697例受试者的多中心研究]

Lhéritier K, Ravaud J F, Desert J F, Pedelucq J P, O'hanna F, Daures J P

Laboratoire d'épidémiologie et de biostatistique, Institut Universitaire de Recherche Clinique, 641, avenue du doyen Gaston Giraud, 34093 Montpellier, France.

Rev Epidemiol Sante Publique. 2001 Oct;49(5):449-58.

BACKGROUND

We surveyed survival and prognosis factors in tetraplegic spinal cord injured persons (TSCI) after their admission to a physical medicine and rehabilitation center.

METHODS

This multicenter study included 697 individuals, the entire cohort of patients admitted to three of the principal French centers caring for spinal cord injured persons from 1949 to 1997. The data set was drawn from the medical files and included data on the accident and its complications, social and demographic features, and the characteristics of the spinal injury. Survival data were obtained for all subjects from the official registries of their place of birth. Univariate (Kaplan-Meier) and multivariate (Cox regression) analysis was made to study links between these data and survival.

RESULTS

Univariate analysis indicated that the principal variables significantly related to survival were: level of the lesion, age at the time of the accident, the cause of the accident, and the presence of a permanent tracheotomy or a depressive syndrome requiring medical care. Multivariate analysis showed that the risk of dying was 82% lower for persons who did not have a permanent tracheotomy. The risk declined by 92%, 89% and 69% for TSCI aged 20 years or less, 20-39 years and 40-59 years respectively at the time of the accident compared with those aged more than 60 years. This risk was 37% lower for TSCI without depressive syndrome and 52% lower for persons injured at levels C6, C7, C8 compared with those injured at levels C2, C3, C4.

CONCLUSION

Multivariate analysis showed that the principal prognosis factors for survival are the presence of a permanent tracheotomy, the age at the time of the accident, the presence of a depressive syndrome and the level of the lesion. No statistical improvement of survival was observed related with time (corresponding to the year of inclusion) but, over the study period, there was an increasing number of spinal cord injured person who survived with high lesions.

背景

我们调查了四肢瘫痪脊髓损伤患者（TSCI）入住物理医学与康复中心后的生存率及预后因素。

方法

这项多中心研究纳入了697名个体，即1949年至1997年间法国三个主要脊髓损伤患者护理中心收治的全部患者队列。数据集取自医疗档案，包括事故及其并发症、社会和人口统计学特征以及脊髓损伤特征的数据。从受试者出生地的官方登记处获取了所有受试者的生存数据。采用单因素（Kaplan-Meier）和多因素（Cox回归）分析来研究这些数据与生存之间的联系。

结果

单因素分析表明，与生存显著相关的主要变量为：损伤平面、事故发生时的年龄、事故原因以及是否存在永久性气管切开术或需要医疗护理的抑郁综合征。多因素分析显示，没有永久性气管切开术的患者死亡风险降低82%。与事故发生时年龄超过60岁的患者相比，事故发生时年龄在20岁及以下、20 - 39岁和40 - 59岁的TSCI患者死亡风险分别降低92%、89%和69%。与C2、C3、C4平面损伤的患者相比，C6、C7、C8平面损伤的TSCI患者死亡风险降低37%，无抑郁综合征的患者死亡风险降低52%。