颈髓损伤后气管切开影响因素的Meta分析
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摘要
目的 :系统评价颈髓损伤后气管切开的影响因素,为制定颈髓损伤患者的呼吸道管理措施提供循证依据。方法:计算机检索Pubmed数据库、Embase生物医学数据库、Medline数据库、Cochrane图书馆、中国生物医学文献服务系统(CBM)、中国期刊全文数据库(CNKI)及万方数据资源系统,收集由建库至2018年2月公开发表的关于颈髓损伤后气管切开影响因素的研究文献。采用Rev Man 5.3软件进行Meta分析,用固定效应模型或随机效应模型进行数据合并,计算比值比(odds ratio,OR)/均数差(mean difference,MD)值和95%可信区间(confidence interval,CI)。用漏斗图来判定发表偏倚。结果 :经过文献筛选共纳入16篇文献,累计颈髓损伤患者9697例,气管切开率为18.3%(1773/9697)。Meta分析结果显示,在颈髓损伤患者中,男性[OR=1.29,95%CI(1.12,1.49),P=0.0004]、ASIA A级[OR=7.79,95%CI(5.28,11.50),P<0.00001]、ASIA B级[OR=1.15,95%CI(1.13,2.02),P=0.005]、ASIA C级[OR=0.28,95%CI(0.20,0.41),P<0.00001]、ASIA D级[OR=0.04,95%CI(0.02,0.09),P<0.00001]、神经损伤水平(高位颈髓损伤)[OR=2.36,95%CI(1.51,3.68),P=0.0002]、损伤严重程度评分(ISS)[MD=8.97,95%CI(8.11,9.82),P<0.00001]、格拉斯哥昏迷评分(GCS)≤8[OR=6.03,95%CI(2.19,16.61),P=0.0005]、合并胸部损伤[OR=1.78,95%CI(1.55,2.04),P<0.00001]、呼吸系统并发症[OR=5.97,95%CI(4.03,8.86),P<0.00001]因素与气管切开指标差异均有统计学意义。而患者年龄、高龄、合并脑损伤、吸烟史、车祸伤机制和跌落伤机制与气管切开无显著相关性(P>0.05)。结论:当前证据表明,男性、ASIA分级A级或B级、神经损伤水平(高位颈髓损伤)、ISS、GCS≤8、合并胸部损伤、呼吸系统并发症是颈髓损伤后气管切开的危险因素,ASIA分级C级或D级是其保护性因素,应根据这些因素指导颈髓损伤患者行气管切开术。
Objetives: To systematically assess the influencing factors of tracheotomy after cervical spinal cord injury, and to provide evidence-based information for developing measures of respiratory management in patients with cervical spinal cord injury. Methods: Pub Med, Embase, Medline, Cochrane Library, Chinese Biological Medical Literature database(CBM), China National Knowledge Infrastructure database(CNKI) and Wanfang database were searched for relevant published literature studying the influencing factors of tracheotomy after cervical spinal cord injury. Meta analysis was performed by using Rev Man 5.3 software,and the data were pooled by using a fixed effect model or a random effect model to calculate the odds ratio(OR)/mean difference(MD) and 95% confidence interval(CI). Publication bias was determined by the funnel plot. Results: Sixteen studies containing 9697 patients with cervical spinal cord injury met the inclusion criteria. The rate of tracheotomy was 18.3%. Meta-analysis showed that there were significant differences in male [OR=1.29, 95%CI(1.12, 1.49), P=0.0004], ASIA A[OR=7.79, 95%CI(5.28, 11.50), P<0.00001], ASIA B[OR=1.15, 95%CI(1.13, 2.02), P=0.005], ASIA C[OR=0.28, 95%CI(0.20, 0.41), P<0.00001], ASIA D[OR=0.04,95%CI(0.02, 0.09), P<0.00001], the neurological level of injury(NLI)[OR=2.36, 95%CI(1.51, 3.68), P=0.0002],injury severity score(ISS) [MD =8.97, 95% CI(8.11, 9.82), P <0.00001], Glasgow Coma Scale(GCS) ≤8 [OR =6.03,95% CI(2.19, 16.61), P =0.0005], thoracic injury [OR =1.78, 95% CI(1.55, 2.04), P <0.00001] and respiratory complications[OR=5.97, 95%CI(4.03, 8.86), P<0.00001] and tracheostomy in patients with cervical spinal cord injury. while there was no significant correlation between the patient′ s age, advanced age, brain injury,smoking history, traffic accident injury and fall injury and tracheostomy(P >0.05). Conclusions: The current evidence shows that male, AIS A, AIS B, the neurological level of injury(upper cervical spinal cord injury),ISS, GCS≤8, thoracic injury, respiratory complication are risk factors for tracheotomy after cervical spinal cord injury. AIS C and AIS D are the protective factors.
Objetives: To systematically assess the influencing factors of tracheotomy after cervical spinal cord injury, and to provide evidence-based information for developing measures of respiratory management in patients with cervical spinal cord injury. Methods: Pub Med, Embase, Medline, Cochrane Library, Chinese Biological Medical Literature database(CBM), China National Knowledge Infrastructure database(CNKI) and Wanfang database were searched for relevant published literature studying the influencing factors of tracheotomy after cervical spinal cord injury. Meta analysis was performed by using Rev Man 5.3 software,and the data were pooled by using a fixed effect model or a random effect model to calculate the odds ratio(OR)/mean difference(MD) and 95% confidence interval(CI). Publication bias was determined by the funnel plot. Results: Sixteen studies containing 9697 patients with cervical spinal cord injury met the inclusion criteria. The rate of tracheotomy was 18.3%. Meta-analysis showed that there were significant differences in male [OR=1.29, 95%CI(1.12, 1.49), P=0.0004], ASIA A[OR=7.79, 95%CI(5.28, 11.50), P<0.00001], ASIA B[OR=1.15, 95%CI(1.13, 2.02), P=0.005], ASIA C[OR=0.28, 95%CI(0.20, 0.41), P<0.00001], ASIA D[OR=0.04,95%CI(0.02, 0.09), P<0.00001], the neurological level of injury(NLI)[OR=2.36, 95%CI(1.51, 3.68), P=0.0002],injury severity score(ISS) [MD =8.97, 95% CI(8.11, 9.82), P <0.00001], Glasgow Coma Scale(GCS) ≤8 [OR =6.03,95% CI(2.19, 16.61), P =0.0005], thoracic injury [OR =1.78, 95% CI(1.55, 2.04), P <0.00001] and respiratory complications[OR=5.97, 95%CI(4.03, 8.86), P<0.00001] and tracheostomy in patients with cervical spinal cord injury. while there was no significant correlation between the patient′ s age, advanced age, brain injury,smoking history, traffic accident injury and fall injury and tracheostomy(P >0.05). Conclusions: The current evidence shows that male, AIS A, AIS B, the neurological level of injury(upper cervical spinal cord injury),ISS, GCS≤8, thoracic injury, respiratory complication are risk factors for tracheotomy after cervical spinal cord injury. AIS C and AIS D are the protective factors.
引文
1.[No authors listed].Spinal Cord Injury(SCI)2016 Facts and Figures at a Glance[J].J Spinal Cord Med,2016,39(4):493-494.
2.Leng YX,Nie CY,Yao ZY,et al.Analysis of the risk factors for early death in acute severe traumatic cervical spinal cord injury[J].Zhonghua Wei Zhong Bing Ji Jiu Yi Xue,2013,25(5):294-297.
3.Brown R,Di Marco AF,Hoit JD,et al.Respiratory dysfunction and management in spinal cord injury[J].Respir Care,2006,51(8):853-868.
4.Flanagan C,Childs BR Moore TA,et al.Early Tracheostomy in Patients with Traumatic Cervical Spinal Cord Injury Appears Safe and May Improve Outcomes[J].Spine,2017 Dec27.doi:10.1097/BRS.0000000000002537.[Epub ahead of print]
5.Romero J,Vari A,Gambarrutta C,et al.Tracheostomy timing in traumatic spinal cord injury[J].Eur Spine J,2009,18(10):1452-1457.
6.Epstein SK.Late complications of tracheostomy[J].Respir Care,2005,50(4):542-549.
7.Dempsey GA,Morton B,Hammell C,et al.Long-Term Outcome Following Tracheostomy in Critical Care:A Systematic Review[J].Crit Care Med,2016,44(3):617-628.
8.Branco BC,Plurad D,Green DJ,et al.Incidence and clinical predictors for tracheostomy after cervical spinal cord injury:a National Trauma Databank review[J].J Trauma,2011,70(1):111-115.
9.Hou YF,Lv Y,Zhou F,et al.Development and validation of a risk prediction model for tracheostomy in acute traumatic cervical spinal cord injury patients[J].Eur Spine J.2015 24(5):975-984.
10.姬彦辉,王玉龙,腾宇.颈髓损伤患者气管切开影响因素的分析[J].临床急诊杂志,2011,12(5):309-311.
11.Lee DS,Park CM,Carriere KC,et al.Classification and regression tree model for predicting tracheostomy in patients with traumatic cervical spinal cord injury[J].Eur Spine J.2017 Apr 26.doi:10.1007/s00586-017-5104-9.[Epub ahead of print]
12.Leelapattana P,Fleming JC,Gurr KR,et al.Predicting the need for tracheostomy in patients with cervical spinal cord injury[J].J Trauma Acute Care Surg,2012,73(4):880-884.
13.李强,朱曦,幺改琦.急性颈脊髓损伤患者气管切开影响因素研究[J].北京医学,2009,31(1):28-30.
14.Mc Cully BH,Fabricant L,Geraci T,et al.Complete cervical spinal cord injury above C6 predicts the need for tracheostomy[J].Am J Surg,2014,207(5):664-668.
15.Menaker J,Kufera JA,Glaser J,et al.Admission ASIA motor score predicting the need for tracheostomy after cervical cord injury[J].J Trauma Acute Care Surg,2013,75(4):629-634.
16.Nakashima H,Yukawa Y,Imagama S,et al.Characterizing the need for tracheostomy placement and decannulation after cervical spinal cord injury[J].Eur Spine J,2013,22(7):1526-1532.
17.Quesnel A,Veber B,Proust F,et al.What are the perspectives for ventilated tetraplegics?A French retrospective study of 108 patients with cervical spinal cord injury[J].2015,58(2):74-77.
18.邵将,贾连顺,朱巍,等.颈髓损伤气管切开影响因素分析[J].中国矫形外科杂志,2007,15(12):885-887,890.
19.施铁柱,陈建洪.创伤性颈脊髓损伤患者气管切开的相关因素分析[J].实用医学杂志,2015,31(22):3750-3752.
20.Tanaka J,Yugue I,Shiba K,et al.A Study of Risk Factors for Tracheostomy in Patients With a Cervical Spinal Cord Injury[J].Spine,2016,41(9):764-771.
21.YuguéI,Okada S,Ueta T,et al.Analysis of the risk factors for tracheostomy in traumatic cervical spinal cord injury[J].Spine,2012,37(26):E1633-1638.
22.Childs BR,Moore TA,Como JJ,et al.American Spinal Injury Association Impairment Scale Predicts the Need for Tracheostomy After Cervical Spinal Cord Injury[J].Spine,2015,40(18):1407-1413.
23.唐辉,李良业,周旭,等.颈髓损伤术后气管切开相关危险因素分析[J].中华实验外科杂志,2016,33(6):1582-1583.
24.Durbin CG Jr.Tracheostomy:why,when,and how?[J].Respir Care,2010,55(8):1056-1068.
25.Austin N,Krishnamoorthy V,Dagal A.Airway management in cervical spine injury[J].Int J Crit Illn Inj Sci,2014,4(1):50-56.
26.Hagen EM,Lie SA,Rekand T,et al.Mortality after traumatic spinal cord injury:50 years of follow-up[J].J Neurol Neurosurg Psychiatry,2010,81(4):368-373.
27.Neumann CR,Brasil AV,Albers F.Risk factors for mortality in traumatic cervical spinal cord injury:Brazilian data[J].J Trauma,2009,67(1):67-70.
28.Berney S,Bragge P,Granger C,et al.The acute respiratory management of cervical spinal cord injury in the first 6weeks after injury:a systematic review[J].Spinal Cord,2011,49(1):17-29.
29.Velmahos GC,Toutouzas K,Chan L,et al.Intubation after cervical spinal cord injury:to be done selectively or routinely?[J].The Am Surg,2003,69:892-894.
30.Isah MD,Makusidi MA,Abbas A,et al.Spirometric evaluation of ventilatory function in adult male cigarette smokers in Sokoto metropolis[J].Niger Postgrad Med J,2017,24(1):1-7.
31.Rogers DF,Barnes PJ.Treatment of airway mucus hypersecretion[J].Ann Med,2006,38(2):116-125.
32.Xiao J,Wang K,Feng YL,et al.Role of extracellular signal-regulated kinase 1/2 in cigarette smoke-induced mucus hypersecretion in a rat model[J].Chin Med J(Engl),2011,124(20):3327-3333.
33.Roquilly A,Seguin P,Mimoz O,et al.Risk factors for prolonged duration of mechanical ventilation in acute traumatic tetraplegic patients--a retrospective cohort study[J].J Crit Care,2014,29(2):313.e7-13.
2.Leng YX,Nie CY,Yao ZY,et al.Analysis of the risk factors for early death in acute severe traumatic cervical spinal cord injury[J].Zhonghua Wei Zhong Bing Ji Jiu Yi Xue,2013,25(5):294-297.
3.Brown R,Di Marco AF,Hoit JD,et al.Respiratory dysfunction and management in spinal cord injury[J].Respir Care,2006,51(8):853-868.
4.Flanagan C,Childs BR Moore TA,et al.Early Tracheostomy in Patients with Traumatic Cervical Spinal Cord Injury Appears Safe and May Improve Outcomes[J].Spine,2017 Dec27.doi:10.1097/BRS.0000000000002537.[Epub ahead of print]
5.Romero J,Vari A,Gambarrutta C,et al.Tracheostomy timing in traumatic spinal cord injury[J].Eur Spine J,2009,18(10):1452-1457.
6.Epstein SK.Late complications of tracheostomy[J].Respir Care,2005,50(4):542-549.
7.Dempsey GA,Morton B,Hammell C,et al.Long-Term Outcome Following Tracheostomy in Critical Care:A Systematic Review[J].Crit Care Med,2016,44(3):617-628.
8.Branco BC,Plurad D,Green DJ,et al.Incidence and clinical predictors for tracheostomy after cervical spinal cord injury:a National Trauma Databank review[J].J Trauma,2011,70(1):111-115.
9.Hou YF,Lv Y,Zhou F,et al.Development and validation of a risk prediction model for tracheostomy in acute traumatic cervical spinal cord injury patients[J].Eur Spine J.2015 24(5):975-984.
10.姬彦辉,王玉龙,腾宇.颈髓损伤患者气管切开影响因素的分析[J].临床急诊杂志,2011,12(5):309-311.
11.Lee DS,Park CM,Carriere KC,et al.Classification and regression tree model for predicting tracheostomy in patients with traumatic cervical spinal cord injury[J].Eur Spine J.2017 Apr 26.doi:10.1007/s00586-017-5104-9.[Epub ahead of print]
12.Leelapattana P,Fleming JC,Gurr KR,et al.Predicting the need for tracheostomy in patients with cervical spinal cord injury[J].J Trauma Acute Care Surg,2012,73(4):880-884.
13.李强,朱曦,幺改琦.急性颈脊髓损伤患者气管切开影响因素研究[J].北京医学,2009,31(1):28-30.
14.Mc Cully BH,Fabricant L,Geraci T,et al.Complete cervical spinal cord injury above C6 predicts the need for tracheostomy[J].Am J Surg,2014,207(5):664-668.
15.Menaker J,Kufera JA,Glaser J,et al.Admission ASIA motor score predicting the need for tracheostomy after cervical cord injury[J].J Trauma Acute Care Surg,2013,75(4):629-634.
16.Nakashima H,Yukawa Y,Imagama S,et al.Characterizing the need for tracheostomy placement and decannulation after cervical spinal cord injury[J].Eur Spine J,2013,22(7):1526-1532.
17.Quesnel A,Veber B,Proust F,et al.What are the perspectives for ventilated tetraplegics?A French retrospective study of 108 patients with cervical spinal cord injury[J].2015,58(2):74-77.
18.邵将,贾连顺,朱巍,等.颈髓损伤气管切开影响因素分析[J].中国矫形外科杂志,2007,15(12):885-887,890.
19.施铁柱,陈建洪.创伤性颈脊髓损伤患者气管切开的相关因素分析[J].实用医学杂志,2015,31(22):3750-3752.
20.Tanaka J,Yugue I,Shiba K,et al.A Study of Risk Factors for Tracheostomy in Patients With a Cervical Spinal Cord Injury[J].Spine,2016,41(9):764-771.
21.YuguéI,Okada S,Ueta T,et al.Analysis of the risk factors for tracheostomy in traumatic cervical spinal cord injury[J].Spine,2012,37(26):E1633-1638.
22.Childs BR,Moore TA,Como JJ,et al.American Spinal Injury Association Impairment Scale Predicts the Need for Tracheostomy After Cervical Spinal Cord Injury[J].Spine,2015,40(18):1407-1413.
23.唐辉,李良业,周旭,等.颈髓损伤术后气管切开相关危险因素分析[J].中华实验外科杂志,2016,33(6):1582-1583.
24.Durbin CG Jr.Tracheostomy:why,when,and how?[J].Respir Care,2010,55(8):1056-1068.
25.Austin N,Krishnamoorthy V,Dagal A.Airway management in cervical spine injury[J].Int J Crit Illn Inj Sci,2014,4(1):50-56.
26.Hagen EM,Lie SA,Rekand T,et al.Mortality after traumatic spinal cord injury:50 years of follow-up[J].J Neurol Neurosurg Psychiatry,2010,81(4):368-373.
27.Neumann CR,Brasil AV,Albers F.Risk factors for mortality in traumatic cervical spinal cord injury:Brazilian data[J].J Trauma,2009,67(1):67-70.
28.Berney S,Bragge P,Granger C,et al.The acute respiratory management of cervical spinal cord injury in the first 6weeks after injury:a systematic review[J].Spinal Cord,2011,49(1):17-29.
29.Velmahos GC,Toutouzas K,Chan L,et al.Intubation after cervical spinal cord injury:to be done selectively or routinely?[J].The Am Surg,2003,69:892-894.
30.Isah MD,Makusidi MA,Abbas A,et al.Spirometric evaluation of ventilatory function in adult male cigarette smokers in Sokoto metropolis[J].Niger Postgrad Med J,2017,24(1):1-7.
31.Rogers DF,Barnes PJ.Treatment of airway mucus hypersecretion[J].Ann Med,2006,38(2):116-125.
32.Xiao J,Wang K,Feng YL,et al.Role of extracellular signal-regulated kinase 1/2 in cigarette smoke-induced mucus hypersecretion in a rat model[J].Chin Med J(Engl),2011,124(20):3327-3333.
33.Roquilly A,Seguin P,Mimoz O,et al.Risk factors for prolonged duration of mechanical ventilation in acute traumatic tetraplegic patients--a retrospective cohort study[J].J Crit Care,2014,29(2):313.e7-13.