一项关于颈椎损伤后气管切开术影响因素的荟萃分析。
A Meta-Analysis of the Influencing Factors for Tracheostomy after Cervical Spinal Cord Injury.
机构信息
Weifang Medical University, No. 288 Shengli Street, Kuiwen District, Weifang, Shandong 261000, China.
The Second Department of Spine Surgery, No. 89 Hospital of PLA, No. 256 Beigongxi Street, Weicheng District, Weifang, Shandong 261000, China.
出版信息
Biomed Res Int. 2018 Jul 12;2018:5895830. doi: 10.1155/2018/5895830. eCollection 2018.
BACKGROUND
Traumatic cervical spinal cord injury (CSCI) is a common disease that has high complication, disability, and mortality rates and a poor prognosis. Tracheostomy is an important supportive therapy for patients with CSCI. However, a consensus on the predictive factors for tracheostomy after CSCI has not been reached.
OBJECTIVE
This meta-analysis study assessed the influencing factors for tracheostomy after CSCI.
METHODS
We searched for relevant studies on the influencing factors for tracheostomy after CSCI. The extracted data were analyzed using RevMan 5.3 software. We calculated the odds ratio (OR) or mean difference (MD) and 95% confidence intervals (CIs).
RESULTS
Sixteen eligible studies containing 9697 patients with CSCI were selected. The pooled OR (MD) and 95% CI of the influencing factors were as follows: age (mean ± SD): -0.98 (-4.00 to 2.03), advanced age: 1.93 (0.80 to 4.63), sex (male): 1.29 (1.12 to 1.49), American Spinal Injury Association Impairment Scale (AIS) A grade: 7.79 (5.28 to 11.50), AIS B grade: 1.15 (1.13 to 2.02), AIS C grade: 0.28 (0.20 to 0.41), AIS D grade: 0.04 (0.02 to 0.09), neurological level of injury (upper CSCI): 2.36 (1.51 to 3.68), injury severity score (ISS): 8.97 (8.11 to 9.82), Glasgow Coma Scale (GCS) score ≤8: 6.03 (2.19 to 16.61), thoracic injury: 1.78 (1.55 to 2.04), brain injury: 0.96 (0.55 to 1.69), respiratory complications: 5.97 (4.03 to 8.86), smoking history: 1.45 (0.99 to 2.13), traffic accident injury: 1.27 (0.92 to 1.74), and fall injury: 0.72 (0.52 to 1.01).
CONCLUSIONS
The current evidence shows that male sex, AIS A grade, AIS B grade, neurological level of injury (upper CSCI), high ISS, GCS≤8, thoracic injury, and respiratory complications are risk factors for tracheostomy after CSCI, and AIS C grade and AIS D grade are protective factors. This study will allow us to use these factors for tracheostomy decisions and ultimately optimize airway management in patients with CSCI.
背景
创伤性颈脊髓损伤（CSCI）是一种常见疾病，具有高并发症、残疾和死亡率以及预后不良的特点。气管切开术是 CSCI 患者的重要支持性治疗方法。然而，对于 CSCI 后行气管切开术的预测因素尚未达成共识。
目的
本荟萃分析研究评估了 CSCI 后行气管切开术的影响因素。
方法
我们检索了有关 CSCI 后行气管切开术影响因素的相关研究。使用 RevMan 5.3 软件对提取的数据进行分析。我们计算了比值比（OR）或均数差（MD）和 95%置信区间（CI）。
结果
共纳入了 16 项包含 9697 例 CSCI 患者的研究。影响因素的汇总 OR（MD）和 95%CI 如下：年龄（均值±标准差）：-0.98（-4.00 至 2.03），年龄较大：1.93（0.80 至 4.63），性别（男性）：1.29（1.12 至 1.49），美国脊髓损伤协会损伤分级（AIS）A级：7.79（5.28 至 11.50），AIS B 级：1.15（1.13 至 2.02），AIS C 级：0.28（0.20 至 0.41），AIS D 级：0.04（0.02 至 0.09），神经损伤水平（高位 CSCI）：2.36（1.51 至 3.68），损伤严重程度评分（ISS）：8.97（8.11 至 9.82），格拉斯哥昏迷量表（GCS）评分≤8：6.03（2.19 至 16.61），胸部损伤：1.78（1.55 至 2.04），脑损伤：0.96（0.55 至 1.69），呼吸并发症：5.97（4.03 至 8.86），吸烟史：1.45（0.99 至 2.13），交通意外伤：1.27（0.92 至 1.74），坠落伤：0.72（0.52 至 1.01）。
结论
目前的证据表明，男性、AIS A 级、AIS B 级、神经损伤水平（高位 CSCI）、高 ISS、GCS≤8、胸部损伤和呼吸并发症是 CSCI 后行气管切开术的危险因素，AIS C 级和 AIS D 级是保护因素。本研究将使我们能够利用这些因素来决定行气管切开术，并最终优化 CSCI 患者的气道管理。
Zotero 插件