重症监护病房中创伤性脊髓损伤患者的神经学转归及预测因素

Neurological outcomes and predictive factors in traumatic spinal cord injury patients in the intensive care unit.

作者信息

Yuan Danqin, Jin Yaling, Chen Lihui, Tang Min, Lin Jiuzhou, Chen Weiting

机构信息

Department of Emergency and Intensive Care Unit, Taizhou Integrated Chinese and Western Medicine Hospital, Taizhou, Zhejiang, China.

Department of Emergency and Intensive Care Unit, The First People's Hospital of Linhai, Taizhou, Zhejiang, China.

出版信息

PLoS One. 2025 May 29;20(5):e0323433. doi: 10.1371/journal.pone.0323433. eCollection 2025.

DOI:10.1371/journal.pone.0323433

PMID:40440334

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12121827/

Abstract

BACKGROUND

This study aims to analyze the demographic characteristics, clinical features, and neurological outcomes of patients with traumatic spinal cord injury (TSCI) admitted to the Intensive Care Unit (ICU), in order to provide scientific evidence for the prevention and management of TSCI.

METHODS

A retrospective analysis was conducted on data from TSCI patients admitted to the ICU between January 2018 and December 2022. Demographic information, neurological injury characteristics, complications during hospitalization, treatment interventions, and prognosis were comprehensively collected. Based on changes in neurological function before and after treatment, patients undergoing surgery were classified into improvement and non-improvement groups. Neurological recovery was assessed using the American Spinal Injury Association (ASIA) impairment scale. Univariate and multivariate logistic regression analyses were performed to identify key factors influencing neurological recovery.

RESULTS

A total of 341 TSCI patients were included, with a mean age of 55.2 ± 13.4 years and a male-to-female ratio of 6.3:1. The leading cause of TSCI were high falls (47.5%), traffic accidents (35.8%) and low falls (9.1%). Cervical spinal cord was most common, followed by thoracic and lumbar cord. Among surgical patients, the neurological improvement rate was 14.8%, compared to 12.5% in non-surgical patients, highlighting the potential benefits of surgical intervention. Multivariate analysis revealed that early targeted blood pressure management (MAP ≥ 85 mmHg) (OR=2.296, 95% CI: 1.036-5.086, P = 0.040) and early surgery (≤ 24h) (OR=2.841, 95% CI: 1.088-7.419, P = 0.033) were significant protective factors for neurological improvement.

CONCLUSIONS

Patients with TSCI admitted to the ICU are predominantly middle-aged men, with high falls and traffic accidents being the primary causes. Early blood pressure optimization and timely surgical intervention are significantly associated with improved neurological outcomes.

摘要

背景

本研究旨在分析入住重症监护病房（ICU）的创伤性脊髓损伤（TSCI）患者的人口统计学特征、临床特征和神经功能结局，以便为TSCI的预防和管理提供科学依据。

方法

对2018年1月至2022年12月期间入住ICU的TSCI患者的数据进行回顾性分析。全面收集人口统计学信息、神经损伤特征、住院期间的并发症、治疗干预措施和预后情况。根据治疗前后神经功能的变化，将接受手术的患者分为改善组和未改善组。使用美国脊髓损伤协会（ASIA）损伤量表评估神经功能恢复情况。进行单因素和多因素逻辑回归分析，以确定影响神经功能恢复的关键因素。

结果

共纳入341例TSCI患者，平均年龄为55.2±13.4岁，男女比例为6.3:1。TSCI的主要原因是高处坠落（47.5%）、交通事故（35.8%）和低处坠落（9.1%）。颈脊髓损伤最为常见，其次是胸脊髓和腰脊髓损伤。在手术患者中，神经功能改善率为14.8%，非手术患者为12.5%，突出了手术干预的潜在益处。多因素分析显示，早期目标血压管理（平均动脉压≥85 mmHg）（OR=2.296，95%可信区间：1.036-5.086，P=0.040）和早期手术（≤24小时）（OR=2.841，95%可信区间：1.088-7.419，P=0.033）是神经功能改善的重要保护因素。