Incidence and severity of acute complications after spinal cord injury
Incidence and severity of acute complications after spinal cord injury
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DOI：
10.3171/2012.5.aospine12127
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发表时间：
2012-09-01
影响因子：
2.8
通讯作者：
Harrop, James S.
中科院分区：
文献类型：
--
作者：
Grossman, Robert G.;Frankowski, Ralph F.;Harrop, James S.
目的。这项多中心、前瞻性研究的目的是确定脊髓损伤患者初次住院期间并发症的范围、发生率和严重程度。方法。该研究在 9 家大学附属医院进行，这些医院包括北美脊髓损伤治疗临床试验网络 (NACTN) 的临床中心。研究人群包括 2005 年 6 月 25 日至 2010 年 11 月 2 日期间入住 NACTN 临床中心的 315 名患者，他们的美国脊柱损伤协会 (ASIA) 损伤量表分级为 A D，年龄在 18 岁或以上。根据标准化方案对患者进行管理。结果。研究人群中 79% 为男性，中位年龄为 44 岁。受伤的主要原因是跌倒（37%）和机动车事故（28%）。最初的 ASIA 成绩分布为 A (40%)、B (16%)、C (15%) 和 D (29%)。 58% 的患者患有一种或多种严重、中度或轻度并发症。并发症与更严重的 ASIA 等级相关：84% 的 A 级患者和 25% 的 D 级患者至少有 l 种并发症。 78% 的并发症发生在受伤后 14 天内。最常见的严重和中度并发症类型是呼吸衰竭、肺炎、胸腔积液、贫血、心律失常和严重心动过缓。死亡率为 3.5%，与年龄增加和既往发病率有关。结论。了解脊髓损伤后发生的特定并发症的类型、频率、发生时间和严重程度有助于早期发现、治疗和预防。这些数据对于评估和选择临床试验的治疗方法非常重要。 （http://thejns.org/doi/abs/10.3171/2012.5.AOSPINE12127）
Object. The aim of this multicenter, prospective study was to determine the spectrum, incidence, and severity of complications during the initial hospitalization of patients with spinal cord injury.Methods. The study was conducted at 9 university-affiliated hospitals that comprise the clinical centers of the North American Clinical Trials Network (NACTN) for Treatment of Spinal Cord Injury. The study population comprised 315 patients admitted to NACTN clinical centers between June 25, 2005, and November 2, 2010, who had American Spinal Injury Association (ASIA) Impairment Scale grades of A D and were 18 years of age or older. Patients were managed according to a standardized protocol.Results. The study population was 79% male with a median age of 44 years. The leading causes of injury were falls (37%) and motor vehicle accidents (28%). The distribution of initial ASIA grades were A (40%), B (16%), C (15%), and D (29%). Fifty-eight percent of patients sustained 1 or more severe, moderate, or mild complications. Complications were associated with more severe ASIA grade: 84% of patients with Grade A and 25% of patients with Grade D had at least l complication. Seventy-eight percent of complications occurred within 14 days of injury. The most frequent types of severe and moderate complications were respiratory failure, pneumonia, pleural effusion, anemia, cardiac dysrhythmia, and severe bradycardia. The mortality rate was 3.5% and was associated with increased age and preexisting morbidity.Conclusions. Knowledge of the type, frequency, time of occurrence, and severity of specific complications that occur after spinal cord injury can aid in their early detection, treatment, and prevention. The data are of importance in evaluating and selecting therapy for clinical trials. (http://thejns.org/doi/abs/10.3171/2012.5.AOSPINE12127)