大剂量甲基强的松龙对急性脊髓损伤的疗效及预后判断

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1、大剂量甲基强的松龙对急性脊髓损伤的疗效及预后判断作者：陆政峰，董启榕，沈忆新，成茂华【摘要】目的探讨大剂量甲基强的松龙(methylprednisolone，MP)对急性脊髓损伤(acutespinalcordinjury，ASCI)的疗效、并发症防治及预后判断。方法将38例ASCI患者根据影像学改变和脊髓功能丧失程度分轻、中、重三度。轻度10例，影像检查无明显异常、脊髓功能部分丧失；中度21例，影像检查轻至中度异常(椎管轻至中度占位，MRI脊髓有信号改变)、脊髓功能部分丧失；重度7例，影像检查重度异常(椎管中至重度占位，MRI显示脊髓断裂)、脊髓功能完全丧失。38例患者在受伤8h内按N

2、ASCISⅡ方案接受MP冲击治疗，分析其疗效和判断预后。结果经6周及6个月随访，MP对轻、中度组患者疗效显著，预后好；重度组疗效及预后差。38例患者住院治疗及随访过程中除1例发生上消化道出血，余无伤口感染、延迟愈合、肺部感染、心率失常等并发症。结论大剂量MP冲击治疗对急性脊髓损伤患者安全有效，对轻、中度患者疗效显著，预后好。【关键词】甲基强的松龙；急性脊髓损伤；疗效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急性脊髓损伤(acutespinalcordinjury，ASCI)迄今为止仍是全球性难题和研究热点。美国第2次全国急性脊髓损伤研究(nationalacutespinalcordinjurystudiesⅡ，NASCISⅡ)［1］制定了大剂量甲基强的松龙(methylprednisolone，MP)治疗ASCI的标准方案(NASCISⅡ方案)，引起广