Blood alcohol concentration as a determinant of outcomes after traumatic spinal cord injury
Blood alcohol concentration as a determinant of outcomes after traumatic spinal cord injury
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DOI：
10.1111/ene.12145
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发表时间：
2013-07-01
影响因子：
5.1
通讯作者：
Fehlings, M. G.
中科院分区：
文献类型：
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作者：
Furlan, J. C.;Fehlings, M. G.
临床前研究表明，乙醇对脊髓损伤（SCI）动物模型的组织保护和运动恢复具有潜在的有害作用。鉴于此，我们对血液酒精浓度（BAC）是否是急性创伤性SCI后生存以及神经和功能恢复的潜在决定因素进行了检查。方法入选第三次全国脊髓损伤研究（NASCIS-3）的所有患者。研究人群分为“非酒精”（BAC等于千分之0）、“法律的”（BAC大于0至千分之0.8）和“非法的”（BAC大于千分之0.8）亚组。结果指标包括生存率、基线时、SCI后6周、6个月和1年时的NASCIS运动和感觉评分、NASCIS疼痛评分和功能独立性测量（Functional Independence Measure，FISD）决定因素。对主要的潜在混杂因素进行了调整：年龄、性别、种族、试验方案、格拉斯哥昏迷评分、SCI的原因、水平和严重程度。结果499例患者（男423例，女76例;年龄14 ~ 92岁），平均BAC为0.054 ± 0.006ppm（0-1）。1年生存率（94.4%）与BAC无关（P=0.374）。此外，BAC与SCI后6周、6个月和1年的运动恢复（0.166）、感觉恢复（0.323）、疼痛评分变化（0.312）或功能恢复（0.133）均无显著相关性。结论我们的研究结果首次表明，急诊入院时的BAC不会对SCI后第一年内患者的死亡率、神经功能缺损或功能障碍产生不利影响。
Background Pre-clinical studies indicate a potential detrimental effect of ethanol on tissue sparing and locomotor recovery in animal models of spinal cord injury (SCI). Given this, an examination of whether blood alcohol concentration (BAC) is a potential determinant of survival and neurological and functional recovery after acute traumatic SCI was carried out. Methods All patients who were enrolled in the Third National Spinal Cord Injury Study (NASCIS-3) were included. The study population was divided into non-alcohol' (BAC equal to 0 parts per thousand), legal' (BAC greater than 0 up to 0.8 parts per thousand) and illegal' (BAC greater than 0.8 parts per thousand) subgroups. Outcome measures included survival, NASCIS motor and sensory scores, NASCIS pain scores and Functional Independence Measure (FIM) determinants at baseline and at 6weeks, 6months and 1year post-SCI. Analyses were adjusted for major potential confounders: age, sex, ethnicity, trial protocol, Glasgow coma score, and cause, level and severity of SCI. Results Among 499 patients (423 males and 76 females; ages from 14 to 92years), the mean BAC was 0.054 +/- 0.006 parts per thousand (range 0-1). The survival at 1year (94.4%) was not associated with the BAC (P=0.374). Moreover, BAC was not significantly correlated with motor recovery (0.166), sensory recovery (0.323), change in pain score (0.312) or functional recovery (0.133) at 6weeks, 6months and 1year post-SCI. Conclusions Our results, for the first time, show that the BAC at emergency admission does not adversely affect the patients' mortality, neurological impairment or functional disability over the course of the first year after SCI.