| 王超宇,亢 毅,娄永富,贺宝荣,吴德升,孟 斌,周恒星,冯世庆.多中心创伤性颈脊髓损伤流行病学分析[J].中国脊柱脊髓杂志,2023,(5):408-416. |
| 多中心创伤性颈脊髓损伤流行病学分析 |
| 中文关键词: 创伤性颈脊髓损伤 流行病学 人口学和临床特征 治疗现状 医疗费用 |
| 中文摘要: |
| 【摘要】 目的：分析2013年~2018年我国多中心创伤性颈脊髓损伤（traumatic cervical spinal cord injury，TCSCI）患者人口学与临床特征的现状和趋势、治疗现状、住院期间费用现状。方法：收集我国13家医院[西安市红会医院、上海市东方医院、天津医科大学总医院、苏州大学附属第一医院、深圳市第二人民医院、上海市第一人民医院、秀山县人民医院、西安交通大学第一附属医院、西安一四一医院（现西安交通大学第一附属医院东院区）、成都大学附属医院、金湖县人民医院、首都医科大学宣武医院、井陉县医院]中TCSCI住院患者的病历资料，包括：性别、年龄、职业、致伤原因、损伤节段、损伤程度、美国脊髓损伤协会残障（ASIA impairment scale，AIS）分级、治疗方式选择、减压手术时间窗、类固醇皮质激素药物[甲泼尼龙琥珀酸钠（methylprednisolone sodium succinate，MPSS）/甲基强地松龙（methylprednisolone，MP）]的使用时间窗。收集患者在住院期间医疗费用和住院时长。统计分析以上数据资料的现状，计算年度变化百分比（annual percentage change，APC）来分析患者人口学和临床特征在6年间的变化趋势；分析患者治疗方式和医疗支出的现状。结果：共纳入2102例TCSCI患者，2013~2018年TCSCI数量呈逐年增加趋势（APC=16.9%，95%CI：10.2~24.1，P＜0.01），患者的平均年龄（APC=1.7%，95%CI：1.0~2.4，P＜0.01）和老年患者所占比例（APC=12.5%，95%CI：6.0~19.3，P＜0.01）呈上升趋势。男性占79.9%，最常见的职业是农民（32.8%）；常见的致伤原因前三位为：摔倒（36.7%）、交通事故（30.0%）、高坠（18.4%）。最常见的损伤节段为C4水平（26.8%），其次是多节段损伤（24.4%）和C5水平（18.9%），有超过半数的患者为不完全性四肢瘫痪（67.8%）和AIS D级（51.9%），截瘫（包括完全性和不完全性）所占比例呈下降趋势。66.0%的患者接受了减压手术治疗，但其中只有2.0%的患者是在伤后24h内进行的手术。有18.2%的患者接受了大剂量MPSS/MP治疗，其中有34.2%的患者在伤后8h内使用；伤后24h以后仍使用大剂量MPSS/MP的有173例，占使用大剂量MPSS/MP患者的45.2%。急性和亚急性期住院总费用平均为6.93万元，日均费用平均为0.42万元。男性患者住院期间总医疗费用和日均医疗费用的均值高于女性。在不同的损伤程度分组中，完全性四肢瘫痪患者住院期间医疗费用最高；在不同AIS分组中，AIS A级的患者住院期间医疗费用最高。结论：TCSCI患者的数量、平均年龄、老年患者占比均在逐年上升，在TCSCI患者的实际临床治疗中，减压手术时间窗、类固醇皮质激素的用法用量等与指南建议并不完全一致。 |
Multicenter epidemiological analysis of traumatic cervical spinal cord injury |
| 英文关键词:Traumatic cervical spinal cord injury Epidemiology Demographic and clinical characteristics Treatment status Medical expenditure |
| 英文摘要: |
| 【Abstract】 Objectives: To analyze the status and trends of demographic and clinical characteristics and the current status of surgical treatment and medical expenditure during hospitalization in patients with traumatic cervical spinal cord injury(TCSCI) from 2013 to 2018. Methods: The medical records of TCSCI inpatients of 13 hospitals in China[Xi′an Honghui Hospital, Shanghai East Hospital, Tianjin Medical University General Hospital, The First Affiliated Hospital of Soochow University, Shenzhen Second People′s Hospital, Shanghai First People′s Hospital, People′s Hospital of Xiushan County, The First Affiliated Hospital of Xi′an Jiaotong University, Xi′an No.141 Hospital(now the East Branch of the First Affiliated Hospital of Xi′an Jiaotong University), The Affiliated Hospital of Chengdu University, Jinhu County People′s Hospital, Xuanwu Hospital Capital Medical University, Hospital of Jingxing County] were collected. The data collected included gender, age, occupation, cause of injury, injury segment, injury severity, American Spinal Injury Association(ASIA) Impairment Scale(AIS grade), the treatment options, decompression surgical time windows, and time windows of corticosteroid drugs[methylprednisolone sodium succinate(MPSS) or methylprednisolone(MP)]. The medical expenses during hospitalization and length of hospital stay were also collected. The current status of the above clinical data was analyzed, and the annual percentage change(APC) was calculated to analyze the trends of the demographic and clinical characteristics over the 6-year period. The current status of treatment and expenditure was analyzed. Results: A total of 2102 TCSCI patients were included in this study. From 2013 to 2018, the number of TCSCI patients showed an increasing trend year by year(APC=16.9%, 95%CI: 10.2-24.1, P<0.01), and the average age of patients(APC=1.7%, 95%CI: 1.0-2.4, P<0.01) and the proportion of the elderly(APC=12.5%, 95%CI: 6.0-19.3, P<0.01) were on the rise constantly. In the study, 79.9% were male, and the most common occupation was farmer(32.8%). The top three causes of injuries were low fall(36.7%), traffic accident(30.0%) and high fall(18.4%). The most common segment of injury was C4 level(26.8%), followed by multi-segments injury(24.4%) and C5 level(18.9%). More than half of the patients were rated as incomplete quadriplegia(67.8%) and AIS D(51.9%). The proportion of paraplegia(including complete and incomplete) was decreasing. Decompression surgery was performed in 66.0% of the patients, but only 2.0% of them were performed within 24 hours after injury. 18.2% of the patients received high dose of MPSS/MP, and 34.2% of them received within 8 hours after injury. There were 173 patients(45.2%) who still used high dose MPSS/MP after 24 hours after injury. The average hospitalization cost in acute and sub-acute phase was 69.3 thousands yuan, and the average daily cost was 4.2 thousands yuan. The average of total medical expenses and daily medical expenses for male patients during hospitalization were higher than those of female patients. Among different injury severity groups, patients rated complete quadriplegia had the highest medical expenditure during hospitalization. Among different AIS grades, patients rated AIS A had the highest medical expenditure during hospitalization. Conclusions: The number, average age, and proportion of the elderly in TCSCI patients all increase year by year. In the actual clinical treatment of TCSCI patients, the time window of decompression surgery and the usage and dosage of corticosteroids are not completely consistent with the recommendations of the guidelines. |
| 投稿时间：2022-07-07 修订日期：2023-04-03 |
| DOI： |
| 基金项目:国家重点研发计划（2019YFA0112100） |
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