大劑量甲基強(qiáng)的松龍對(duì)急性脊髓損傷的療效及預(yù)后判斷

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1、大劑量甲基強(qiáng)的松龍對(duì)急性脊髓損傷的療效及預(yù)后判斷作者：陸政峰，董啟榕，沈憶新，成茂華【摘要】目的探討大劑量甲基強(qiáng)的松龍(methylprednisolone，MP)對(duì)急性脊髓損傷(acutespinalcordinjury，ASCI)的療效、并發(fā)癥防治及預(yù)后判斷。方法將38例ASCI患者根據(jù)影像學(xué)改變和脊髓功能喪失程度分輕、中、重三度。輕度10例，影像檢查無明顯異常、脊髓功能部分喪失；中度21例，影像檢查輕至中度異常(椎管輕至中度占位，MRI脊髓有信號(hào)改變)、脊髓功能部分喪失；重度7例，影像檢查重度異常(椎管中至重度占位，MRI顯示脊髓斷裂)、脊髓功能完全喪失。38例患者在受傷8h內(nèi)按N

2、ASCISⅡ方案接受MP沖擊治療，分析其療效和判斷預(yù)后。結(jié)果經(jīng)6周及6個(gè)月隨訪，MP對(duì)輕、中度組患者療效顯著，預(yù)后好；重度組療效及預(yù)后差。38例患者住院治療及隨訪過程中除1例發(fā)生上消化道出血，余無傷口感染、延遲愈合、肺部感染、心率失常等并發(fā)癥。結(jié)論大劑量MP沖擊治療對(duì)急性脊髓損傷患者安全有效，對(duì)輕、中度患者療效顯著，預(yù)后好?！娟P(guān)鍵詞】甲基強(qiáng)的松龍；急性脊髓損傷；療效Abstract：ObjectiveToinvestigatetheeffectandcomplicationsofhighdosemethylprednisolone(MP)inpatients10ofacutespina

3、lcordinjury(ASCI)aswellastoestimatetheprognosis.Methods38casesofASCIwereclassifiedintoslight，midrangeandseveredegrees，basedontheirimagingchangesandfunctionallesionofspinalcord.Therewere10casesofslightinjury，ofwhichthespinalcordspartlylosttheirfunctionwithoutimagingchanges.21casesofmidrangeinjuryi

4、ndicatedthatthefunctionsofspinalcordswerepartlydeprivedwithmoderateimagingchanges(Theinvolvedvertebralcanalwascompressedslightlyormoderately，andMRIshowedsignalchangeinsidethespinalcord).7casesofsevereinjurymeantthepatientsparalyzedthoroughlywithseriousimagingchanges(Theinvolvedvertebralcanalwasco

5、mpressedmoderatelyorseverely，andMRIindicatedthatspinalcordhadbroken).The38casesweretreatedwithhighdoseMPaccordingtoNASCISⅡrole.Thentheeffectandcomplicationswereanalyzed，andtheprognoseswerediscussedaswell.ResultsAfter6weeks′and6months′followinguprespectively，wefindthatthepatientsofslightandmidran

6、geinjurygotasatisfyingoutcomes，butsevereinjuredpatientsrespondedineffectivelytotreatmentandtheprognosiswerepoor.NomoreMPrelatedcomplicationswereobservedexceptonecaseofupperalimentarytracthemorrhage.ConclusionHighdoseMPisaneffectiveandsafetreatmenttoslightandmidrangeASCI10patients.Keywords：methyl

7、prednisolone；acutespinalcordinjury；effect急性脊髓損傷(acutespinalcordinjury，ASCI)迄今為止仍是全球性難題和研究熱點(diǎn)。美國第2次全國急性脊髓損傷研究(nationalacutespinalcordinjurystudiesⅡ，NASCISⅡ)［1］制定了大劑量甲基強(qiáng)的松龍(methylprednisolone，MP)治療ASCI的標(biāo)準(zhǔn)方案(NASCISⅡ方案)，引起廣