Tuli Sagun, Tuli Jayshree, Coleman William P, Geisler Fred H, Krassioukov Andrei
ICORD, University of British Columbia, Vancouver, BC, Canada.
J Spinal Cord Med. 2007;30(5):482-90. doi: 10.1080/10790268.2007.11754582.
BACKGROUND/OBJECTIVES: To evaluate the relationship between the severity of cervical spinal cord injury (SCI) (American Spinal Injury Association [ASIA] grade), presence of neurogenic shock, and timing of surgical intervention. This is a post-hoc analysis from the Sygen multicenter randomized controlled trial.
Blood pressure (BP) and heart rate (HR) data were collected when patients were first assessed in the emergency room (Time A) and at the time of randomization (Time B). Individuals were subdivided by ASIA grade and by the level of the systolic BP (SBP).
Only individuals with cervical SCI from the Sygen trial (n = 577) were evaluated. Severe complete SCI (ASIA grade = A) was established in 57% of these patients. A total of 74 (13%) patients with neurogenic shock (SBP < 90 mmHg) at Time A were identified. The SBP increased significantly from Time A to Time B (P < 0.0001). The median time from SCI to surgical intervention, for ASIA A, was 80.9 hours for patients with initial SBP < 90 mmHg and 58 hours for patients with initial SBP > or = 90 mmHg (P = 0.025). Multivariable analysis after adjusting for confounders revealed a statistically significant difference in the time to surgical intervention based on SBP for ASIA A (P = 0.026), yet not for ASIA B or C/D.
The presence of neurogenic shock was associated with a delay in the timing of surgical intervention in patients with cervical SCI. Detailed evaluation of autonomic dysfunctions following SCI including cardiovascular instability could improve our understanding of the complexities of clinical presentations and possible neurological outcomes.
背景/目的：评估颈脊髓损伤（SCI）的严重程度（美国脊髓损伤协会[ASIA]分级）、神经源性休克的存在与手术干预时机之间的关系。这是一项来自Sygen多中心随机对照试验的事后分析。
在患者首次于急诊室评估时（时间A）和随机分组时（时间B）收集血压（BP）和心率（HR）数据。个体按ASIA分级和收缩压（SBP）水平进行细分。
仅对Sygen试验中患有颈SCI的个体（n = 577）进行了评估。这些患者中有57%被确定为严重完全性SCI（ASIA分级 = A）。在时间A时，共识别出74例（13%）患有神经源性休克（SBP < 90 mmHg）的患者。SBP从时间A到时间B显著升高（P < 0.0001）。对于ASIA A级患者，初始SBP < 90 mmHg者从SCI到手术干预的中位时间为80.9小时，初始SBP≥90 mmHg者为58小时（P = 0.025）。在对混杂因素进行调整后的多变量分析显示，基于SBP的ASIA A级患者手术干预时间存在统计学显著差异（P = 0.026），而ASIA B级或C/D级患者则无差异。
神经源性休克的存在与颈SCI患者手术干预时机的延迟有关。对SCI后自主神经功能障碍（包括心血管不稳定）进行详细评估，可能会增进我们对临床表现复杂性和可能的神经学结果的理解。
