颈椎手术患者术后发生硬膜外血肿危险因素的Meta分析

A meta-analysis of risk factors for postoperative epidural hematoma in patients undergoing cervical spinal surgery

中文关键词:  颈椎手术  硬膜外血肿  危险因素  Meta分析

英文关键词:Cervical surgery  Epidural hematoma  Risk factors  Meta analysis

中文摘要:

  【摘要】 目的：系统评价颈椎手术患者术后发生硬膜外血肿的相关危险因素。方法：通过计算机检索PubMed、Embase、the Cochrane Library、Web of Science、中国知网（CNKI）、万方数据库（Wanfang）、维普数据库（VIP）和中国生物医学文献数据库（CBM），自建库至2023年4月公开发表的有关颈椎手术患者术后发生硬膜外血肿的回顾性或前瞻性研究，2名评价者分别按照纳入与排除标准对所获文献进行文献筛选，采用NOS量表进行质量评价，提纳取入文献的基本信息，包括年龄、性别及体质指数（body mass index，BMI）以及与颈椎术后硬膜外血肿发生相关研究因素（如手术节段、是否合并后纵韧带骨化、手术时间、糖尿病史、高血压病史、吸烟史、非甾体抗炎药的使用以及实验室相关指标等），通过RevMan 5.4软件进行Meta分析。采用漏斗图对纳入的研究进行偏倚风险分析。结果：共纳入12篇文献，纳入文献的NOS质量评分均在6~8分，其中11篇为高质量研究，1篇为中质量研究。Meta分析显示：男性[比值比（odds ratio，OR）=2.84，95%可信区间（confidence interval，CI）（1.73，4.67），P＜0.0001]、BMI＞24kg/m2[OR=8.50，95%CI（2.56，25.24），P=0.0005]、多手术节段（手术节段≥2）[OR=2.26，95%CI（1.42，3.59），P=0.0005]、手术时长＞2h[OR=1.46，95%CI（1.08，1.97），P＝0.01]、术前服用非甾体类抗炎药物[OR=3.60，95%CI（1.00，12.99），P=0.05]是颈椎术后发生硬膜外血肿的危险因素。采用漏斗图对纳入文献最多的影响因素手术节段及术中出血量进行发表偏倚检验结果显示手术节段不存在发表偏倚，而术后出血量存在部分发表偏倚。结论：男性、BMI过大、多节段手术、手术时间长、术前服用非甾体类抗炎类药物等是颈椎术后SEH发生的危险因素。

英文摘要:

  【Abstract】 Objectives: To systematically evaluate the risk factors associated with postoperative epidural hematoma in patients undergoing cervical spinal surgery. Methods: PubMed, Embase, the Cochrane Library, Web of Science, CNKI, Wanfang databases, VIP databases and CBM were searched by computer for retrospective or prospective studies on epidural hematoma in patients undergoing cervical spine surgery published since the inception of the databases to April 2023. Two reviewers screened the literatures according to the inclusion and exclusion criteria, and NOS scale was used to evaluate the quality of the literature included. The basic information of the study, including age, gender and body mass index(BMI), as well as the factors related to the occurrence of epidural hematoma after cervical spine surgery, such as surgical segment, whether combined with posterior longitudinal ligament ossification, operative time, diabetes, hypertension, smoking, use of non-steroidal anti-inflammatory drugs and laboratory related indicators were extracted. The risk of bias analysis of the included studies was performed using funnel plots, and meta-analysis was performed using RevMan 5.4 software. Results: A total of 12 literatures were included, and the NOS quality scores of the included literatures were all 6-8 points, of which, 11 were of high quality and 1 was of medium quality. Meta-analysis showed that male[odds ratio(OR)=2.84, 95% confidence interval(CI)(1.73, 4.67), P＜0.0001], BMI＞24kg/m2 [OR=8.50, 95%CI(2.56, 25.24), P=0.0005], multiple surgical segments(≥2) [OR=2.26, 95%CI(1.42, 3.594), P=0.0005], operative time>2h[OR=1.46, 95%CI(1.08, 1.97), P=0.01], preoperative administration of nonsteroidal anti-inflammatory drugs[OR=3.60, 95% CI(1.00, 12.99), P=0.05] were the risk factors for epidural hematoma after cervical spine surgery. The results of the funnel plot were used to test the publication bias of the surgical segment and intraoperative blood loss, which were the most influential factors in the literature, and the results showed that there was no publication bias in the surgical segment, while there was partial publication bias in the intraoperative blood loss. Conclusions: Male, BMI＞24kg/m2, multi-segment surgery(surgical segment≥2), operative time>2h, and preoperative administration of nonsteroidal anti-inflammatory drugs are the risk factors for SEH after cervical spine surgery.