| 摘要: | 本研究是選擇都會區（台北市）及非都會區（花蓮縣）作研究範圍。
利用回溯方式(retrospective)， 抄錄自民國八十九年六月至民國九十年六月間，在台北市18家及花蓮縣4家，共22家醫院，首次住院的新發生脊髓傷害病患資料。收集的內容包括各種人口學資料、臨床數據、治療經過及結果，並利用脊髓損傷調查表為抄錄工具，將上述資料轉變為包括年齡、性別、過去內科病史、過去脊椎病史、酒精使用、傷害原因、受傷至住院時間、到院前轉院次數、到院時平均血壓、到院時動脈收縮壓、到院時GCS、到院時RTS、脊椎傷害節數、脊椎傷害完全度、脊椎傷害嚴重度、合併傷害、脊髓影像診斷、外科手術、復健治療、醫院級數、醫院所在地等共21項自變項（independent variable），及10項評估治療結果的預後變項(outcome variable)。然後利用統計學方法，比較急性脊髓傷害2種治療方法（使用methylprednisolone及不使用methylprednisolone）的治療結果及併發症。同時利用統計學的方法（多變項分析），分析methylprednisolone治療與各自變項（independent variable）及依變項的相關性。
評估治療結果包括以下10項短期預後指標（short-term outcome）：
1. 住院平均天數
2. 加護病房平均天數
3. 呼吸器使用平均天數
4. 施行氣管切開術人數
5. 住院至復健平均天數
6. 病人在出院時運動機能的改變
7. 病人在治療後六週時運動機能的改變
8. 住院中死亡人數
9. 住院中併發症次數
10. 住院中併發症的各類別。
研究結果發現，使用methylprednisolone治療的外傷性急性脊髓傷害病人，在住院中出現較多的感染症(P value=0.038)。而其他各短期預後指標，則無統計學上明顯的差異。
OBJECTIVES: This study is intended to investigate the clinical outcome with and without methylprednisolone (MP) treatment in 110 patients who suffered from acute traumatic spinal cord injury in Taiwan.
METHOD: This is a retrospective review of the medical reports of patients who had acute traumatic spinal cord injury in 18 hospitals in Taipei City (urban area) and 4 hospitals in Hualien County (rural area) during the last 12-month period from June 1,2000 to May 31,2001.
The data of 110 patients aged between 16 and 90 years were collected and evaluated for their neurological status. The patients with isolated nerve-root disorder and open neck wound were excluded from this study. The subjects were divided into two groups: those treated with methylprednisolone and those without methylprednisolone after hospital admission.
Comparisons of those two groups included 21 demographic and clinical characteristics: age, sex, cause of injury, the number of associated injuries, use of alcohol, time elapsed between the injury and admission, number of hospital transfers before treatment, spinal cord injury (SCI) severity, SCI level, SCI completeness, past history of major diseases, past history of spinal disease, mean blood pressure on admission, systolic BP on admission, Revised Trauma Score on admission, CT diagnosis of the spine, MRI diagnosis of the spine, level of the hospital, location of the hospital, surgery after admission, and rehabilitation after admission.
RESULTS:
Outcome measure MP Non-MP P value
Mean length of hospitalization (day) 45.28 31.94 0.144
Mean length of stay in ICU (day) 4.99 3.39 0.37
Mean length of respirator use (day) 18.87 8.36 0.071
Number of tracheotomy 9 3 0.532
Mean duration from hospital
admission to the start of
rehabilitation (day) 25.82 25.13 0.922
Mean score of in-hospital
motor function change 2.18 1.45 0.764
Mean score of motor function
change six weeks after the treatment 2.76 0.20 0.057
Number of in-hospital mortality 2 1 0.714
Frequency of in-hospital
complications 1.29 0.87 0.099
Number of respiratory failure 9 4 0.483
Number of infectious disease 42 17 0.038
Number of UGI bleeding 6 1 0.418
Number of neurogenic bladder 25 10 0.303
CONCLUSION: The results of this study suggest that the patients with SCI are more likely to have infectious complications if receiving methylprednisolone. However, there are no significant differences among other outcome parameters whether the patients receive methylprednisolone treatment. |
