大剂量甲基强的松龙对急性脊髓损伤的疗效及预后判断_临床医学论文.docVIP

大剂量甲基强的松龙对急性脊髓损伤的疗效及预后判断_临床医学论文 大剂量甲基强的松龙对急性脊髓损伤的疗效及预后判断_临床医学论文 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(acute spinal cord injury，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8 h内按NASCIS Ⅱ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：Objective To investigate the effect and complications of high，midrange and severe degrees，based on their imaging changes and functional lesion of spinal cord.There were 10 cases of slight injury，of which the spinal cords partly lost their function without imaging changes.21 cases of midrange injury indicated that the functions of spinal cords were partly deprived with moderate imaging changes(The involved vertebral canal was compressed slightly or moderately，and MRI showed signal change inside the spinal cord).7 cases of severe injury meant the patients paralyzed thoroughly with serious imaging changes(The involved vertebral canal was compressed moderately or severely，and MRI indicated that spinal cord had broken).The 38 cases were treated with high，and the prognoses were discussed as well.Results After 6 weeks′and 6 months′following up respectively，we find that the patients of slight and midrange injury got a satisfying outcomes，but severe injured patients responded ineffectively to treatment and the prognosis were poor.No more MP related complications were observed except one case of upper alimentary tract hemorrhage.Conclusion Highdose MP is an effective and safe treatment to slight and midrange ASCI patients. Key words：methylprednisolone；acute spinal cord injury；effect 急性脊髓损伤(acute spinal cord injury，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(national acute spinal cord injury studiesⅡ，NASCISⅡ)［1］制定了大剂量甲基强的松龙(methylprednisolo