腰椎手术患者术后发生症状性硬膜外血肿危险因素的Meta分析

A meta-analysis of risk factors for symptomatic epidural hematoma after lumbar spine surgery

中文关键词:  腰椎手术  症状性硬膜外血肿  危险因素  Meta分析

英文关键词:Lumbar surgery  Symptomatic epidural hematoma  Risk factors  Meta analysis

中文摘要:

  【摘要】 目的：通过系统评价的方法分析腰椎手术患者术后症状性硬膜外血肿（postoperative symptomatic epid-ural hematoma，PSEH）发生的相关危险因素。方法：计算机检索PubMed、Embase、Web of Science、Cochrane Library、CBM、CNKI、万方和维普数据库，搜集有关腰椎手术患者术后发生PSEH危险因素的病例-对照研究和队列研究，检索时限均为建库至2022年3月。由2名研究者独立筛选文献、提取纳入研究的基本信息、基线特征及PSEH相关的危险因素，如手术时间、术中出血量、抗凝治疗等所关注的结局指标和结果测量数据。评价纳入研究的偏倚风险后，采用RevMan 5.3软件进行Meta分析。结果：共纳入17项研究，包括14项病例-对照研究和3项队列研究，共132363例患者，发生症状性硬膜外血肿525例。16篇文献的质量评分均≥6分，仅1篇文献质量评分为5分。Meta分析结果显示，年龄≥65岁[比值比（odds ratio，OR）=3.36，95%可信区间（confidence interval，CI）（2.13，5.30），P<0.00001]、术前血小板计数[OR=1.89，95%CI（1.31，2.71），P=0.0006]、合并高血压[OR=1.50，95%CI（1.22，1.85），P=0.0001]、止血材料使用[OR=2.91，95%CI（1.93，4.39），P<0.00001]、凝血障碍[OR=6.95，95%CI（1.76，27.43），P=0.006]、翻修手术[OR=5.87，95%CI（3.77，9.12），P<0.00001]、手术时间＞2h[OR=3.52，95%CI（1.84，6.71），P=0.0001]、术中出血量≥600ml[OR=3.77，95%CI（1.31，10.89），P=0.01]、冰冻血浆输注[OR=8.13，95%CI（4.46，14.81），P<0.00001]及多节段手术[OR=1.98，95%CI（1.54，2.56），P<0.00001]是腰椎术后患者PSEH发生的危险因素。结论：当前证据表明，年龄≥65岁、术前血小板降低、合并高血压、止血材料使用、凝血障碍、翻修手术、手术时间＞2h、术中出血量≥600ml、冰冻血浆输注及多节段手术为腰椎术后患者PSEH发生的危险因素。对具有以上危险因素的高危患者应高度关注及早期干预，以降低PSEH的发生率，改善患者临床预后。

英文摘要:

  【Abstract】 Objectives: To analyze the risk factors of postoperative symptomatic epidural hematoma(PSEH) in patients undergoing lumbar spine surgery by systematic review. Methods: Case-control studies and cohort studies on the risk factors of PSEH in patients undergoing lumbar surgery were collected by searching PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI, Wanfang and VIP databases. The retrieval time limit was from the database construction to March 2022. Two researchers independently screened the literature and extracted the basic information, baseline characteristics and PSEH-related risk factors of the included studies, such as operation time, intraoperative blood loss, anticoagulant therapy and other outcome indicators and outcome measurement data. After evaluating the risk of bias in the included studies, RevMan 5.3 software was used for Meta-analysis. Results: A total of 17 studies were included, including 14 case-control studies and 3 cohort studies, involving 132,363 patients, and 525 of whom developed PSEH. The quality score of 16 out of 17 papers was all ≥6, and only 1 paper had a quality score of 5. Meta-analysis results showed that: Age ≥65 years [OR=3.36, 95%CI(2.13, 5.30), P=0.00001], preoperative platelet count[OR=1.89, 95%CI(1.31, 2.71), P=0.0006], combined hypertension[OR=1.50, 95%CI(1.22, 1.85), P=0.0001], use of hemostatic materials[OR=2.91，95%CI(1.93, 4.39), P<0.00001], coagulation disorder[OR=6.95, 95%CI (1.76, 27.43), P=0.006], revision surgery[OR=5.87, 95%CI(3.77, 9.12), P<0.00001], operative time ＞2h[OR=3.52, 95%CI (1.84, 6.71), P=0.0001], intraoperative blood loss ≥600ml[OR=3.77, 95%CI(1.31, 10.89), P=0.01], frozen plasma infusion[OR=8.13, 95%CI (4.46, 14.81), P<0.00001] and multilevel operation[OR=1.98, 95%CI(1.54, 2.56), P<0.00001] were independent risk factors for PSEH in patients with lumbar spine surgery. Conclusions: Current evidence indicates that age ≥65 years, preoperative thrombocytopenia, hypertension, use of hemostatic materials, coagulation disorders, revision surgery, operation time ＞2h, intraoperative blood loss ≥600ml, frozen plasma infusion, and multilevel surgery are the risk factors for PSEH in patients with lumbar spine surgery. In order to reduce the incidence of PSEH and improve the clinical prognosis, great attention should be paid and early intervention should be taken to high-risk patients with the above risk factors.