对于粗大运动功能分类系统IV - V级的脑瘫患者，在脊柱融合术前进行鞘内注射巴氯芬治疗。

Intrathecal Baclofen Therapy Prior to Spinal Fusion for Patients With Gross Motor Function Classification System IV-V Cerebral Palsy.

作者信息

Buxton Kristin, Difazio Rachel, Morgan Ann, McCabe Margaret, Forbes Peter W

机构信息

Kristin Buxton, MS, RN, CPNP, Nurse Practitioner, Baclofen Pump Program, Boston Children's Hospital, Boston, MA. Rachel Difazio, PhD, RN, PPCNP-BC, FAAN, Nurse Scientist, Boston Children's Hospital, Boston, MA. Ann Morgan, MS, RN, CPNP, Nurse Practitioner, Baclofen Pump Program, Boston Children's Hospital, Boston, MA. Margaret McCabe, PhD, RN, PNP, Nurse Scientist, Boston Children's Hospital, Boston, MA. Peter W. Forbes, MA, Statistician, Boston Children's Hospital, Boston, MA.

出版信息

Orthop Nurs. 2018 Mar/Apr;37(2):136-143. doi: 10.1097/NOR.0000000000000434.

DOI:10.1097/NOR.0000000000000434

PMID:29570548

Abstract

BACKGROUND

Patients with Gross Motor Function Classification System (GMFCS) IV-V cerebral palsy (CP) have significant spasticity and frequently develop scoliosis. Intrathecal baclofen (ITB) pumps are effective in managing spasticity. The effect of ITB therapy on the postoperative course following spinal fusion in patients with GMFCS IV-V CP has not been described. This study sought to compare postoperative recovery, including complications, in patients using ITB therapy with those with no ITB therapy.

PURPOSE

Evaluate the effect of ITB on the postoperative recovery for patients with GMFCS IV-V CP who undergo spinal fusion for scoliosis.

METHODS

Health records for patients with GMFCS IV-V CP who underwent a spinal fusion for scoliosis at a major quaternary-care children's hospital from January 2009 to October 2015 were reviewed and relevant data were abstracted. Descriptive statistics and regression models were used to compare patients.

RESULTS

Sixty-nine patients were included-19 ITB therapy and 50 no ITB therapy. Demographic and operative characteristics were similar across groups. The mean length of stay for patients in the ITB therapy group was 11.2 days and 14.3 days for the no ITB therapy group, with no difference between groups (p = .12). Pain scores in both groups decreased at the same rate, with scores in the ITB therapy group averaging one-half point lower (p = .32). The average amount of morphine equivalents (p = .71) and benzodiazepine equivalents (p = .53) used were similar between groups. Complication rates were significantly different between groups. Four (21%) of the ITB therapy patients had 1 or more complications whereas 28 (56%, p = .01) in the no ITB therapy group had 1 or more complications. The average number of complications per patient in the ITB therapy group was 0.3 (SD: 0.075, range: 0-3) and the no ITB therapy group was 1.1 (SD: 1.1, range: 0-6, p = .01).

CONCLUSIONS

There was no significant difference in length of stay, pain scores, or pain/spasticity medication use between groups after spinal fusion, but there was a significantly lower incidence of complications in the ITB therapy group.

摘要

背景

粗大运动功能分类系统（GMFCS）IV - V级的脑瘫（CP）患者存在明显的痉挛，且经常发生脊柱侧弯。鞘内注射巴氯芬（ITB）泵在控制痉挛方面有效。GMFCS IV - V级CP患者脊柱融合术后ITB治疗的效果尚未见报道。本研究旨在比较使用ITB治疗的患者与未使用ITB治疗的患者术后恢复情况，包括并发症。

目的

评估ITB对因脊柱侧弯接受脊柱融合术的GMFCS IV - V级CP患者术后恢复的影响。

方法

回顾了2009年1月至2015年10月在一家大型四级儿童专科医院因脊柱侧弯接受脊柱融合术的GMFCS IV - V级CP患者的健康记录，并提取了相关数据。使用描述性统计和回归模型对患者进行比较。

结果

纳入69例患者，19例接受ITB治疗，50例未接受ITB治疗。两组的人口统计学和手术特征相似。ITB治疗组患者的平均住院时间为11.2天，未接受ITB治疗组为14.3天，两组之间无差异（p = 0.12）。两组疼痛评分下降速率相同，ITB治疗组评分平均低0.5分（p = 0.32）。两组使用的吗啡当量（p = 0.71）和苯二氮卓当量（p = 0.53）平均用量相似。两组并发症发生率有显著差异。ITB治疗组4例（21%）患者发生1种或更多并发症，而未接受ITB治疗组28例（56%，p = 0.01）发生1种或更多并发症。ITB治疗组患者平均并发症数为0.3（标准差：0.075，范围：0 - 3），未接受ITB治疗组为1.1（标准差：1.1，范围：0 - 6，p = 0.01）。