颈髓损伤后气管切开影响因素的Meta分析

Influencing factors of tracheotomy after cervical spinal cord injury: a Meta-analysis

中文关键词:  颈髓损伤  气管切开  影响因素  Meta分析

英文关键词:Cervical spinal cord injury  Tracheotomy  Influencing factors  Meta-analysis

中文摘要:

  【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。

英文摘要:

  【Abstract】 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: PubMed, 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.