完全性脊髓损伤患者医院获得性压疮的预测因素：回顾性病例对照研究。
Predictors of hospital-acquired pressure injuries in patients with complete spinal cord injury: a retrospective case-control study.
机构信息
Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
出版信息
BMC Musculoskelet Disord. 2023 Apr 26;24(1):329. doi: 10.1186/s12891-023-06369-y.
BACKGROUND
Despite current best practices, pressure injuries (PI) remain a devastating and prevalent hospital-acquired complication for patients with acute traumatic spinal cord injuries (SCIs). This study examined associations between risk factors for PI development in patients with complete SCI, such as norepinephrine dose and duration, and other demographic factors or lesion characteristics.
METHODS
This case-control study included adults with acute complete SCIs ASIA-A, who were admitted to a level-one trauma center between 2014-18. A retrospective review was implement using data on patient and injury characteristics, including age, gender, level of SCI (cervical vs. thoracic), Injury Severity Score (ISS), length of stay (LOS) and mortality; presence/absence of PI during their acute hospital stay; and treatment factors such as spinal surgery, mean arterial pressure (MAP) targets, and vasopressor treatment. Multivariable logistic regression evaluated associations with PI.
RESULTS
Eighty-two out of 103 eligible patients had complete data, and 30 (37%) developed PIs. Patient and injury characteristics, including age (Mean: 50.6; SD:21.3), location of SCI (48 cervical, 59%) and ISS (Mean 33.1; SD:11.8), did not differ between PI and non-PI groups. Logistic regression analysis revealed that male gender (OR:34.1; CI:2.3-506.5, p = 0.010) and increased LOS (log-transformed; OR:20.5, CI:2.8-149.9, p = 0.003) were associated with increased risk of PI. Having an order for a MAP > 80mmg (OR:0.05; CI:0.01-0.30, p = 0.001) was associated with a reduced risk of PI. There were no significant associations between PI and duration of norepinephrine treatment.
CONCLUSIONS
Norepinephrine treatment parameters were not associated with development of PI, suggesting that MAP targets should be a focus for future investigations for SCI management. Increasing LOS should highlight the need for high-risk PI prevention and vigilance.
背景
尽管目前有最佳实践，压力性损伤（PI）仍然是急性创伤性脊髓损伤（SCI）患者普遍存在的破坏性院内并发症。本研究检查了与完全性 SCI 患者 PI 发展相关的风险因素，如去甲肾上腺素剂量和持续时间，以及其他人口统计学因素或损伤特征。
方法
这项病例对照研究纳入了 2014 年至 2018 年期间入住一级创伤中心的急性完全性 SCI 患者（ASIA-A）。使用患者和损伤特征的数据（包括年龄、性别、SCI 水平（颈椎与胸段）、损伤严重程度评分（ISS）、住院时间（LOS）和死亡率）进行回顾性审查；在急性住院期间是否存在 PI；以及脊髓手术、平均动脉压（MAP）目标和血管加压剂治疗等治疗因素。多变量逻辑回归评估了与 PI 的关联。
结果
在 103 名符合条件的患者中，有 82 名患者有完整的数据，其中 30 名（37%）发生了 PI。PI 和非 PI 组之间的患者和损伤特征，包括年龄（均值：50.6；标准差：21.3）、SCI 位置（48 例颈椎，59%）和 ISS（均值 33.1；标准差：11.8）均无差异。逻辑回归分析显示，男性（OR：34.1；CI：2.3-506.5，p = 0.010）和 LOS 增加（对数转换；OR：20.5；CI：2.8-149.9，p = 0.003）与 PI 风险增加相关。有 MAP > 80mmHg 的医嘱（OR：0.05；CI：0.01-0.30，p = 0.001）与 PI 风险降低相关。去甲肾上腺素治疗持续时间与 PI 之间无显著关联。
结论
去甲肾上腺素治疗参数与 PI 发展无关，这表明 MAP 目标应成为 SCI 管理未来研究的重点。LOS 增加应强调高危 PI 预防和警惕的必要性。
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