Necking Erik, Levi Richard, Ertzgaard Per
Department of Rehabilitation Medicine, Region Östergötland & Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Department of Rehabilitation Medicine, Region Östergötland & Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Clin Neurol Neurosurg. 2021 Apr 2;205:106630. doi: 10.1016/j.clineuro.2021.106630.
Determination of types and frequencies of complications related to ITDD therapy, and assessment of possible risk factors for such complications.
Retrospective study (1999-2014) including all ITDD-implantations at one regional center in Sweden. Descriptors comprised: sex; age; medical condition; body weight index; preoperative ASA-grade; presence of indwelling urinary catheters, feeding tubes, and/or daily urinary or anal incontinence; primary or re-implantation; type of pump and catheter; drug delivered; weekday of surgery; surgical procedure time; surgeon; experience of surgeon; surgical theater; and type of antibiotic prophylaxis. All deaths during the study period were assessed as regards possible relation to ITDD. Data were analyzed with SPSS 25, using Chi test for correlations between descriptors and complications.
231 ITDD pump implantations/re-implantations occurred in 159 patients. Seventy-eight (34%) instances of complications were found: 33 catheter-associated; 6 pump-associated; and 29 infection-associated, where 16 were surgical site infections. A higher infection rate occurred in pump re-implantations, as compared to primary implantations (p = 0.002), and in patients with traumatic spinal cord injury (TSCI) as compared to other diagnoses (p = 0.02). Cloxacillin as antibiotic prophylaxis correlated with a higher infection risk (p = 0.005) relative to other antibiotic prophylaxis. Prolonged surgical procedure time in re-implantations correlated positively with increased catheter-associated complications (p = 0.006).
Complications in ITDD therapy were common, comprising catheter-, infection-, and pump-associated mishaps. A comprehensive system of care needs to be present for managing complications. Future studies may show less complications due to improved protocols and equipment.
确定与植入式鞘内药物输注系统（ITDD）治疗相关的并发症类型及发生率，并评估此类并发症的可能风险因素。
进行回顾性研究（1999 - 2014年），纳入瑞典某地区中心所有接受ITDD植入的患者。记录指标包括：性别、年龄、病情、体重指数、术前美国麻醉医师协会（ASA）分级、是否留置导尿管、饲管和/或日常尿失禁或大便失禁情况、初次植入或再次植入、泵和导管类型、输注药物、手术日期、手术时间、外科医生、外科医生经验、手术室以及抗生素预防类型。评估研究期间所有死亡病例与ITDD的可能关系。使用SPSS 25软件进行数据分析，采用卡方检验分析记录指标与并发症之间的相关性。
159例患者共进行了231次ITDD泵植入/再次植入。发现78例（34%）并发症：33例与导管相关；6例与泵相关；29例与感染相关，其中16例为手术部位感染。与初次植入相比，再次植入泵时感染率更高（p = 0.002）；与其他诊断相比，创伤性脊髓损伤（TSCI）患者感染率更高（p = 0.02）。与其他抗生素预防措施相比，使用氯唑西林进行抗生素预防与更高的感染风险相关（p = 0.005）。再次植入时手术时间延长与导管相关并发症增加呈正相关（p = 0.006）。
ITDD治疗中的并发症很常见，包括与导管、感染和泵相关的不良事件。需要一个综合护理系统来管理并发症。未来的研究可能会显示，由于方案和设备的改进，并发症会减少。
