天津市脊髓损伤流行病学调查研究
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摘要
目的回顾性调查2004年1月至2008年12月天津市居民脊髓损伤的流行病学情况,并通过与其他国家的数据相比较,分析天津市脊髓损伤的流行病学特点,以期有针对性地采取有效的预防措施,降低脊髓损伤的发病率、病死率。同时统计脊髓损伤患者的急性期住院时间,分析人口学因素和临床因素对其影响,以期减少脊髓损伤患者的住院时间,降低住院费用,来合理分配社会医疗资源。资料与方法查阅国内外脊髓损伤流行病学的相关文献,并在听取专家建议的基础上,设计《天津市脊髓损伤住院患者回顾性分析调查表》,查阅2004年1月至2008年12月间天津市收治脊髓损伤的三级和部分二级医院收治的15岁及以上的脊髓损伤患者病历,所调查的流行病学数据包括医院名称、患者的年龄、性别、婚姻状况、职业、居住地址、损伤日期、入院日期、致伤原因、损伤水平(颈段、胸段、腰段或骶段)、损伤程度(完全性四肢瘫、不完全性四肢瘫、完全性截瘫、不完全性截瘫)、合并损伤、ASIA评分、是否转院及转院名称、住院区域,出院日期、与否手术、手术日期、手术方式、并发症、基础疾病以及死亡原因等。资料收集后,对所有的调查表格进行严格的核查讨论,排除调查内容缺失达20%或以上的患者,录入计算机。
结果共统计到869例患者,年发病率为23.7/100万,男女比例为5.63：1,年龄范围为16-90岁,平均年龄为46.0±14.2岁(其中男性45.8±14.2岁,女性47.5±14.5岁)。跌倒是主要致伤原因,占37.6%,其次为交通事故,占34.1%。随着年龄的增加,跌倒伤所占的比例越来越高,而青壮年的致伤原因主要以交通事故为主。颈段、胸段及腰段脊髓损伤所占比例依次为71.5%、13.3%、15.1%。颈脊髓损伤的患者以老年者为多,跌倒伤是主要原因；胸腰段脊髓损伤主要见于交通事故伤。四肢瘫(71.5%)所占比例高于截瘫(28.5%),其中4/5的四肢瘫病例为不完全性脊髓损伤。按ASIA分级,A级、B级、C级和D级所占比例依次为25.2%、18.2%、14.7%、41.9%。在所有的脊髓损伤患者中,合并其他部位损伤患者占62.8%,主要包括脊柱骨折脱位,额面部损伤,四肢及骨盆骨折脱位等。住院期间出现并发症的患者占20.8%,主要包括呼吸系统并发症,泌尿系统并发症及低钠血症。接受手术治疗的患者占55.4%。住院期间病死率为1.4%,死亡患者均为颈脊髓损伤,因呼吸衰竭死亡的患者占91.7%。关于急性期住院时间的研究共纳入脊髓损伤患者842例,住院时间中位数为20天(Q=23),其分布为偏态分布。进一步分析人口学因素和临床因素对急性期住院时间的影响：性别不是急性期住院时间的预测指标；急性期住院时间随着患者年龄的增长而逐渐缩短；与高处坠落、交通事故和重物砸伤致伤的患者相比,跌倒致伤的患者急性期住院时间较短；完全性脊髓损伤患者的急性期住院时间较长；合并损伤和并发症能显著延长患者的急性期住院时间；手术作为一个独立的影响因素,可以延长患者的急性期住院时间；此外,郊区医院的脊髓损伤患者急性期住院时间要明显长于市区医院的患者。
结论目前,在我国全国性或地区性的脊髓损伤流行病学调查开展的较少。本研究的调查结果可反映出,我国脊髓损伤的年发病率相对较高,而且我国人口基数较大,我国的脊髓损伤患者数量庞大,且逐年增长。我国脊髓损伤的发病年龄较高,男性多发,致伤原因主要为跌倒,交通事故次之,这与其他多数发展中国家情况相似。在所有病例中,颈脊髓损伤占多数,不完全性损伤比例高。与其他国家相比,住院期间病死率较低。应该根据脊髓损伤的流行病学特点及其发展趋势采取有针对性的预防和急救措施。关于急性期住院时间,天津市脊髓损伤患者的急性期住院时间与其他国家有所不同。统计结果表明,病因、严重程度、合并损伤、并发症、手术情况和住院区域都对急性期住院时间有显著影响。然而,性别对急性期住院时间无影响。因此,为了缩短患者急性期住院时间,减少住院费用,掌握并处理好这些因素非常重要。
Objective Epidemiology of spinal cord injury (SCI) was surveyed retrospectively from January2004to December2008in Tianjin residents. The epidemiological characteristics of SCI in Tianjin was analyzed by comparison with data from other countries, which would help in taking effective preventive measures to reduce the incidence and mortality of SCI. The influence of demographic and clinical factors to the acute care length of stay (ACLOS) was analyzed, which would help in reducing the hospitalization time and the hospitalization expenses of patients with SCI and distributing the social health care resources reasonably.
Materials and Methods Based on the epidemiological literatures of spinal cord injury and the advices from experts, the retrospectively analyzed questionnaire of hospitalized patients in Tianjin was designed. This study included all SCI patients aged15years or older who were admitted to tertiary hospitals in Tianjin from2004to2008. Epidemiological characteristics, such as age, sex, marital status, occupation, time of injury, date of admission, causes of injury, level of injury (cervical, thoracic, lumbar or sacrum), extent of injury (complete tetraplegia, incomplete tetraplegia, complete paraplegia and incomplete paraplegia), America Spinal Injury Association impairment scale, associated injuries, location of hospitalization, surgery or not, date of discharge, the cause of death were included. After data collection, the strict verification was performed to rule out the incomplete questionnaires (20%or more) and all remaining data was entered into the computer.
Results A total of869patients were collected, with an estimated annual incidence was23.7per million. The male/female ratio was5.63:1. Mean age of SCI was46.0±14.2years (men45.8±14.2years, women47.5±14.5years), with a range of16-90years. Fall (37.6%) was regarded as the leading causes of injury, followed by motor vehicle collision (34.1%). With age increasing, proportion of falls was higher and higher; while motor vehicle collision was the main cause in the young adults. The lesion level was cervical in71.5%, thoracic in13.3%and lumbar/sacral in15.2%. Cervical spinal cord injury mainly occurred in the aged and the main cause was fall while thoracolumbar spinal cord injury mainly caused by motor vehicle collision. The frequency of tetraplegia (71.5%) was higher than paraplegia (28.5%), and roughly four-fifth of tetraplegia cases were incomplete injury. According to the America spinal injury association (ASIA) impairment scale, the proportion of class A, B, C and D was25.2%,18.2%,14.7%,41.9%respectively. In all patients with spinal cord injury,62.8%accompanied with the associated injuries, including spinal fractures, head and facial injuries, fractures of the limbs and pelvis. During the hospitalization,20.8%of patients occurred with complications, including the complications of respiratory system and urinary and hyponatremia.55.4%of patients underwent surgeries and the hospital mortality was1.4%. All deaths were caused by cervical injuries and patients died of respiratory failure accounting for91.7%.842cases were selected to do the study on the ACLOS and the median was20days (Q=23), which showed the skewed distribution. Further statistical conclusion was as follow:gender was not an predictor for ACLOS; ACLOS became shorter with age gradually; patients injured by "low fall" were prone to hospitalize for a shorter time than that of "high fall","motor vehicle collision" and "struck by object" groups; acute hospitalization was significantly longer for complete injury; associate injury and complications could prolong ACLOS obviously; surgery, as an independent influencing factor, was related to longer ACLOS; furthermore, the ACLOS of patients in suburban hospitals was also significantly longer than that of patients in urban hospitals.
Conclusion At present, there were few epidemiology surveys of SCI carried out in China. This study showed that the incidence of SCI was lower compared to the developed countries and the absolute number of SCI was more because of the larger population base. Compared with the most developing countries, age of patients with SCI was older. Male patients were more than females, and the main cause was fall with motor vehicle collision followed, which showed the similarities with the most developing countries. In all cases, the cervical injuries accounted for bigger proportion and the incomplete injuries were more than the complete ones. Compared with other countries, hospital mortality was lower. The targeted preventions and first aid measures should be taken according to the epidemiological characteristics and developmental trend of SCI. For the ACLOS, the length of stay in Tianjin was different from other countries. The ACLOS took on different characteristics. Statistical analysis demonstrated that etiology, severity of injury, associated injury, complications, surgery and geographic location of the hospitalization all affected ACLOS significantly. However, the effect of gender on ACLOS was a null hypothesis. So in order to shorten the ACLOS, it was significant to manage these risk factors correctly.
结果共统计到869例患者,年发病率为23.7/100万,男女比例为5.63：1,年龄范围为16-90岁,平均年龄为46.0±14.2岁(其中男性45.8±14.2岁,女性47.5±14.5岁)。跌倒是主要致伤原因,占37.6%,其次为交通事故,占34.1%。随着年龄的增加,跌倒伤所占的比例越来越高,而青壮年的致伤原因主要以交通事故为主。颈段、胸段及腰段脊髓损伤所占比例依次为71.5%、13.3%、15.1%。颈脊髓损伤的患者以老年者为多,跌倒伤是主要原因；胸腰段脊髓损伤主要见于交通事故伤。四肢瘫(71.5%)所占比例高于截瘫(28.5%),其中4/5的四肢瘫病例为不完全性脊髓损伤。按ASIA分级,A级、B级、C级和D级所占比例依次为25.2%、18.2%、14.7%、41.9%。在所有的脊髓损伤患者中,合并其他部位损伤患者占62.8%,主要包括脊柱骨折脱位,额面部损伤,四肢及骨盆骨折脱位等。住院期间出现并发症的患者占20.8%,主要包括呼吸系统并发症,泌尿系统并发症及低钠血症。接受手术治疗的患者占55.4%。住院期间病死率为1.4%,死亡患者均为颈脊髓损伤,因呼吸衰竭死亡的患者占91.7%。关于急性期住院时间的研究共纳入脊髓损伤患者842例,住院时间中位数为20天(Q=23),其分布为偏态分布。进一步分析人口学因素和临床因素对急性期住院时间的影响：性别不是急性期住院时间的预测指标；急性期住院时间随着患者年龄的增长而逐渐缩短；与高处坠落、交通事故和重物砸伤致伤的患者相比,跌倒致伤的患者急性期住院时间较短；完全性脊髓损伤患者的急性期住院时间较长；合并损伤和并发症能显著延长患者的急性期住院时间；手术作为一个独立的影响因素,可以延长患者的急性期住院时间；此外,郊区医院的脊髓损伤患者急性期住院时间要明显长于市区医院的患者。
结论目前,在我国全国性或地区性的脊髓损伤流行病学调查开展的较少。本研究的调查结果可反映出,我国脊髓损伤的年发病率相对较高,而且我国人口基数较大,我国的脊髓损伤患者数量庞大,且逐年增长。我国脊髓损伤的发病年龄较高,男性多发,致伤原因主要为跌倒,交通事故次之,这与其他多数发展中国家情况相似。在所有病例中,颈脊髓损伤占多数,不完全性损伤比例高。与其他国家相比,住院期间病死率较低。应该根据脊髓损伤的流行病学特点及其发展趋势采取有针对性的预防和急救措施。关于急性期住院时间,天津市脊髓损伤患者的急性期住院时间与其他国家有所不同。统计结果表明,病因、严重程度、合并损伤、并发症、手术情况和住院区域都对急性期住院时间有显著影响。然而,性别对急性期住院时间无影响。因此,为了缩短患者急性期住院时间,减少住院费用,掌握并处理好这些因素非常重要。
Objective Epidemiology of spinal cord injury (SCI) was surveyed retrospectively from January2004to December2008in Tianjin residents. The epidemiological characteristics of SCI in Tianjin was analyzed by comparison with data from other countries, which would help in taking effective preventive measures to reduce the incidence and mortality of SCI. The influence of demographic and clinical factors to the acute care length of stay (ACLOS) was analyzed, which would help in reducing the hospitalization time and the hospitalization expenses of patients with SCI and distributing the social health care resources reasonably.
Materials and Methods Based on the epidemiological literatures of spinal cord injury and the advices from experts, the retrospectively analyzed questionnaire of hospitalized patients in Tianjin was designed. This study included all SCI patients aged15years or older who were admitted to tertiary hospitals in Tianjin from2004to2008. Epidemiological characteristics, such as age, sex, marital status, occupation, time of injury, date of admission, causes of injury, level of injury (cervical, thoracic, lumbar or sacrum), extent of injury (complete tetraplegia, incomplete tetraplegia, complete paraplegia and incomplete paraplegia), America Spinal Injury Association impairment scale, associated injuries, location of hospitalization, surgery or not, date of discharge, the cause of death were included. After data collection, the strict verification was performed to rule out the incomplete questionnaires (20%or more) and all remaining data was entered into the computer.
Results A total of869patients were collected, with an estimated annual incidence was23.7per million. The male/female ratio was5.63:1. Mean age of SCI was46.0±14.2years (men45.8±14.2years, women47.5±14.5years), with a range of16-90years. Fall (37.6%) was regarded as the leading causes of injury, followed by motor vehicle collision (34.1%). With age increasing, proportion of falls was higher and higher; while motor vehicle collision was the main cause in the young adults. The lesion level was cervical in71.5%, thoracic in13.3%and lumbar/sacral in15.2%. Cervical spinal cord injury mainly occurred in the aged and the main cause was fall while thoracolumbar spinal cord injury mainly caused by motor vehicle collision. The frequency of tetraplegia (71.5%) was higher than paraplegia (28.5%), and roughly four-fifth of tetraplegia cases were incomplete injury. According to the America spinal injury association (ASIA) impairment scale, the proportion of class A, B, C and D was25.2%,18.2%,14.7%,41.9%respectively. In all patients with spinal cord injury,62.8%accompanied with the associated injuries, including spinal fractures, head and facial injuries, fractures of the limbs and pelvis. During the hospitalization,20.8%of patients occurred with complications, including the complications of respiratory system and urinary and hyponatremia.55.4%of patients underwent surgeries and the hospital mortality was1.4%. All deaths were caused by cervical injuries and patients died of respiratory failure accounting for91.7%.842cases were selected to do the study on the ACLOS and the median was20days (Q=23), which showed the skewed distribution. Further statistical conclusion was as follow:gender was not an predictor for ACLOS; ACLOS became shorter with age gradually; patients injured by "low fall" were prone to hospitalize for a shorter time than that of "high fall","motor vehicle collision" and "struck by object" groups; acute hospitalization was significantly longer for complete injury; associate injury and complications could prolong ACLOS obviously; surgery, as an independent influencing factor, was related to longer ACLOS; furthermore, the ACLOS of patients in suburban hospitals was also significantly longer than that of patients in urban hospitals.
Conclusion At present, there were few epidemiology surveys of SCI carried out in China. This study showed that the incidence of SCI was lower compared to the developed countries and the absolute number of SCI was more because of the larger population base. Compared with the most developing countries, age of patients with SCI was older. Male patients were more than females, and the main cause was fall with motor vehicle collision followed, which showed the similarities with the most developing countries. In all cases, the cervical injuries accounted for bigger proportion and the incomplete injuries were more than the complete ones. Compared with other countries, hospital mortality was lower. The targeted preventions and first aid measures should be taken according to the epidemiological characteristics and developmental trend of SCI. For the ACLOS, the length of stay in Tianjin was different from other countries. The ACLOS took on different characteristics. Statistical analysis demonstrated that etiology, severity of injury, associated injury, complications, surgery and geographic location of the hospitalization all affected ACLOS significantly. However, the effect of gender on ACLOS was a null hypothesis. So in order to shorten the ACLOS, it was significant to manage these risk factors correctly.
引文
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