Tracheostomy in amyotrophic lateral sclerosis: a 10-year population-based study in Italy
Tracheostomy in amyotrophic lateral sclerosis: a 10-year population-based study in Italy
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DOI：
10.1136/jnnp.2009.175984
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发表时间：
2010-10-01
影响因子：
11
通讯作者：
Mora, G.
中科院分区：
文献类型：
--
作者：
Chio, A.;Calvo, A.;Mora, G.
我们使用来自皮埃蒙特和瓦莱达奥斯塔 ALS 登记册的数据评估了肌萎缩侧索硬化症 (ALS) 气管切开术的临床特征和结果，该登记册是一个前瞻性流行病学登记册，收集了意大利两个地区的所有 ALS 事件病例。 1995 年至 2004 年期间发生的 1260 名患者中，134 名（10.6%）接受了气管切开术。年轻男性患者更有可能接受气管切开术。发病部位（球部与脊柱）和诊断时期（1995-1999 年与 2000-2004 年）并不影响气管造口术的可能性。平均住院时间为 52.0 天 (SD 60.5)。总体而言，27 名患者在住院期间死亡（20.1%）。 65 名患者（48.5%）出院回家，42 名患者（31.3%）住进长期护理机构。气管切开术后的中位生存时间为 253 天。在Cox多变量模型中，与较长生存期独立相关的因素是肠内营养、年龄、婚姻状况和ALS中心随访。总之，在流行病学背景下，气管切开术后 ALS 生存期< 1 年。社会文化因素会影响选择气管切开术的可能性，即使在像意大利这样高度社会化的卫生系统中也是如此。
We evaluated the clinical characteristics and outcome of tracheostomy in amyotrophic lateral sclerosis (ALS) using data from the Piemonte and Valle d'Aosta Register for ALS, a prospective epidemiological register collecting all ALS incident cases in two Italian regions. Among the 1260 patients incident in the period 1995-2004, 134 (10.6%) underwent tracheostomy. Young male patients were more likely to be tracheostomised. Site of onset (bulbar vs spinal) and period of diagnosis (1995-1999 vs 2000-2004) did not influence the likelihood of being tracheostomised. The mean duration of hospital stay was 52.0 days (SD 60.5). Overall, 27 patients died while still in hospital (20.1%). Sixty-five patients (48.5%) were discharged to home, whereas 42 (31.3%) were admitted to long-term care facilities. The median survival time after tracheostomy was 253 days. In the Cox multivariable model, the factors independently related to a longer survival were enteral nutrition, age, marital status and ALS centre follow-up. In conclusion, in an epidemiological setting, ALS survival after tracheostomy was < 1 year. Sociocultural factors influence the probability of choice to be tracheostomised, even in a highly socialised health system as Italian one.