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同时创伤性脑损伤延迟了创伤性脊髓损伤患者的手术
Tej D Azad1, Divyaansh Raj1, Kathleen R Ran1
1Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Neurosurgery
|January 10, 2024
概括
创伤性脑损伤 (TBI) 往往会推迟对患有创伤性脊髓损伤 (tSCI) 的患者进行手术. 这种延迟在严重的TBI病例中更为明显,突出了迅速TBI和SCI管理的必要性.
科学领域:
- 神经外科 神经外科
- 创伤外科 手术 创伤外科
- 神经学 神经学
背景情况:
- 对于创伤性脊髓损伤 (tSCI) 患者来说,迅速的手术减压至关重要.
- 同时的创伤性脑损伤 (TBI) 影响了10-30%的TSCI患者,可能会延迟诊断和治疗.
- 在现实世界中,SCI和TBI的联合管理需要进一步调查.
研究的目的:
- 为了确定同时发生的TBI对SCI患者手术干预时间的影响.
- 分析一组具有和没有TBI的SCI患者的全国队列中的手术延迟率.
主要方法:
- 使用来自国家创伤数据库 (2007-2016) 的数据.
- 包括经过手术干预的STSI患者;延迟手术定义为入院后>24小时.
- 采用多变量等级回归来评估TBI和手术延迟之间的关联,作为次要结果,获得了良好的放出.
主要成果:
- 确定了14964名手术管理的TSCI患者;16.3%的患者同时患有TBI.
- 患有TBI的患者手术的中位时间为24.8小时,没有TBI的患者为20.0小时.
- 同时的TBI独立与延迟手术相关 (OR,1.3;95% CI,1.1-1.6);严重的TBI进一步增加了延迟风险 (OR,1.4;95% CI,1.0-1.9).
结论:
- 同时的TBI显著延迟了SCI患者的手术管理.
- 在严重的TBI的情况下,延迟最为显著.
- 提高对STSI和TBI结合的认识对于防止时间敏感的外科干预延迟至关重要.
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