摘要
目的:通过循证医学之系统评价方法探讨颈椎前路术后吞咽困难的危险因素。方法:检索中国知网、中国生物医学文献数据库、维普网、万方数据库、The Cochrane Library、PubMed、Embase等数据库,时间范围设定为自建库至2023年7月1日,收集数据库中关于颈椎前路术后吞咽困难危险因素的病例对照研究和队列研究。对选取的文献进行数据提取,采用纽卡斯尔—渥太华量表进行文献质量评价,最后使用RevMan5.4统计软件进行Meta分析。结果:本次研究共纳入29篇文献,共计7 487例患者,发生吞咽困难1 640例。Meta分析结果显示:女性[OR=2.93,95%CI(2.45,3.51),P<0.000 01]、年龄[MD=5.82,95%CI(3.91,7.73),P<0.000 01]、吸烟[OR=2.48,95%CI(1.89,3.27),P<0.000 01]、糖尿病[OR=2.41,95%CI(1.41,4.12),P=0.001]、手术节段≥2 level[OR=2.10,95%CI(1.73,2.56),P<0.000 01]、手术节段位置[OR=2.21,95%CI(1.64,2.98),P<0.000 01]、手术时间[MD=24.73,95%CI(14.66,34.79),P<0.000 01]、使用钛板[OR=5.93,95%CI(3.62,9.71),P<0.000 01]、术后椎前软组织肿胀[MD=1.77,95%CI(0.04,3.50),P=0.04]、dC2-7Cobb角[MD=2.36,95%CI(1.34,3.37),P<0.000 01]是颈椎前路术后吞咽困难的危险因素;术前气管推移训练[OR=0.26,95%CI(0.17,0.41),P<0.000 01]是颈椎前路术后吞咽困难的保护因素;术后0-C2角[MD=-1.65,95%CI(-5.05,1.76),P=0.34]、术后C2-7Cobb角[MD=3.45,95%CI(-0.07,6.98),P=0.05]与颈椎前路术后吞咽困难的关联无统计学意义。结论:女性、年龄、吸烟、糖尿病、手术时间、手术节段≥2 level、手术节段位置、使用钛板、术后椎前软组织肿胀、dC2-7Cobb角是颈椎前路术后吞咽困难的危险因素,术前气管推移训练是颈椎前路术后吞咽困难的保护因素。临床医生可根据这些因素提前与患者沟通术后出现吞咽困难的可能性,做好术后吞咽困难的预防工作,减少术后吞咽困难的发生。
Objective:To apply evidence-based medicine for systematically evaluating the risk factors for dysphagia after ante-rior cervical spine surgeries.Methods:Relevant papers included were retrieved with a time range from the establishment of the da-tabasis to July 1st,2023 from databases including CNKI,CBM,VIP,Wanfang database,The Cochrane Library,Embase,PubMed and collected case-control studies and cohort studies of risk factors for dysphagia after anterior cervical spine surgeries.Newcastle-Ottawa Scale was used to extracted research data and evaluated the quality of the included literature,then use the Rev-Man5.4 statistical software for meta-analysis evaluation.Results:A total of 29 papers and 7487 patients were included in this anal-ysis,1640 patients of whom developed dysphagia.And the Meta analysis of the data showed that female[OR=2.93,95%CI(2.45,3.51),P<0.00001],age[MD=5.82,95%CI(3.91,7.73),P<0.00001],smoking[OR=2.48,95%CI(1.89,3.27),P<0.00001],diabetes[OR=2.41,95%CI(1.41,4.12),P=0.001],surgical level≥2 level[OR=2.10,95%CI(1.73,2.56),P<0.00001],surgical segment location[OR=2.21,95%CI(1.64,2.98),P<0.00001],operation time[MD=24.73,95%CI(14.66,34.79),P<0.00001],use of plate[OR=5.93,95%CI(3.62,9.71),P<0.00001],postoperative prevertebral soft tis-sue swelling[MD=1.77,95%CI(0.04,3.50),P=0.04],dC2-7Cobb angle[MD=2.36,95%CI(1.34,3.37),P<0.00001]are risk factors for dysphagia after anterior cervical spine surgeries;preoperative tracheal stretch exercise[OR=0.26,95%CI(0.17,0.41),P<0.00001]are protective factors for dysphagia after anterior cervical spine surgeries;there was no statistically significant association between postoperative 0-C2 angle[MD=-1.65,95%CI(-5.05,1.76),P=0.34],postoperative C2-7Cobb angle[MD=3.45,95%CI(-0.07,6.98),P=0.05]and dysphagia after anterior cervical spine surgeries.Conclusion:Female,age,smoking,diabetes,surgical level≥2 level,surgical segment location,operation time,use of plate,postoperative prevertebral soft tissue swelling,and dC2-7Cobb angle are risk factors for dysphagia after ant
作者
赵文生
李孝林
彭昌华
陈洪卫
邓佳
张朝驹
何川
ZHAO Wensheng;LI Xiaolin;PENG Changhua;CHEN Hongwei;DENG Jia;ZHANG Chaoju;HE Chuan(Hubei University of Chinese Medicine,Wuhan 430061,China;Yangtze University,Jingzhou 434023,China;Jingzhou Hospital of Traditional Chinese Medicine Affiliated to Hubei University of Chinese Medicine,J ingzhou 434000,China)
出处
《海南医学院学报》
CAS
北大核心
2024年第11期850-860,共11页
Journal of Hainan Medical University
基金
全国名老中医专家传承工作室建设项目[国中医药人教函(2022)75号]。
