大剂量甲泼尼龙在脊髓损伤治疗中的早期应用

甲泼尼龙（MP）在急性脊髓损伤（acute spinal cord injury。ASEI）的治疗中得到广泛的应用，并已有了规范性的治疗方案。我院自2005年2月至2006年8月共收治10例脊髓损伤患者，采用规范性的MP冲击治疗，取得一定效果，报告如下。     

甲泼尼龙和神经节苷脂联用对大鼠脊髓损伤CD95表达的影响

目的:研究甲泼尼龙(MP)加神经节苷脂(GM-1)对大鼠脊髓损伤的疗效.方法:采用Allen′s法制备脊髓损伤大鼠模型.将动物模型随机分为4组,即A组:生理盐水对照组;B组:MP治疗组;C组:GM-1治疗组;D组:MP GM-1联合治疗组.上述大鼠在存活不同时间后,分别进行行为学观察,再处死大鼠,取伤段脊髓做石蜡切片,进行苏木素-伊红(HE)染色和CD95单克隆抗体免疫组化检测.结果:HE染色显示脊髓组织病理学改变,B、C、D组明显轻于A组,而D组较B、C组轻.伤后2周行为学指标优差依次为D-C-B-A(P＜0.05).免疫组化检测表明,A组脊髓灰质CD95免疫染色阳性细胞数在 8 h 达到高峰,在白质中 48 h 时达到高峰,而D组虽有高峰,但明显较A组少(P＜0.01),D组较B、C组亦少(P＜0.01).结论:MP与GM-1联合应用可阻断神经细胞的凋亡,对损伤的脊髓组织有良好的保护作用,并促进神经功能的恢复.     

注射用甲泼尼龙琥珀酸钠治疗急性脊髓损伤的疗效观察

目的：探讨大剂量甲泼尼龙琥珀酸钠冲击治疗急性脊髓损伤的疗效观察。方法：对2010年3月～2011年2月期间在本科住院的33例接受大剂量甲泼尼龙琥珀酸钠冲击治疗的急性脊髓损伤患者进行观察。结果：33例患者半年到1年内回访15例患者Frankel分级提高了2级,16例患者提高了1级,2例患者无明显变化。结论：大剂量注射用甲泼尼龙琥珀酸钠冲击治疗急性脊髓损伤是临床中一种疗效确切、安全可靠的治疗方案。     

大剂量甲泼尼龙冲击治疗急性脊髓损伤的观察和护理

近年来基础研究和临床研究均证明大剂量甲泼尼龙冲击治疗对继发性脊髓损伤的恢复是有益的,是目前临床上惟一用于干预性治疗急性脊髓损伤的药物。我科2006年7月-2009年7月采用大剂量甲泼尼龙冲击疗法治疗急性脊髓损伤患者37例,取得了良好的临床效果,现将护理体会报道如下。     

甲泼尼龙治疗重型颅脑损伤的临床体会

目的用大剂量甲泼尼龙对急性重型颅脑损伤治疗的疗效体会作一综述。方法对急性颅脑损伤后的6h之内,使用甲泼尼龙24h静脉冲击的治疗方案进行临床研究。结果大剂量甲泼尼龙冲击治疗组的恢复良好率较对照组高,死亡率降低。结论大剂量甲泼尼龙冲击治疗对急性重型颅脑损伤的治疗有助于提高疗效和降低死亡率。     

大剂量甲强龙冲击疗法治疗急性脊髓损伤近期疗效观察及护理研究

目的 探讨应用大剂量甲基强的松龙(MP)冲击治疗急性脊髓损伤的近期疗效,观察其并发症,总结护理经验.方法 对我院80例急性脊髓损伤患者行大剂量甲基强的松龙(MP)冲击治疗及相应护理.结果 治疗前感觉评分为(27.6 ±11.42),治疗后为(70.8±19.12);治疗前运动评分为(22.4±9.60),治疗后为(56.2±23.46).治疗过程中出现消化道反应4例、心血管疾患1例、尿路感染5例、肺部感染4例,无一例创口感染.结论 对于急性脊髓损伤患者,采用大剂量MP冲击治疗可以有效预防脊髓的继发性损伤,改善脊髓神经功能治.疗中、治疗后的护理和观察是确保治疗成功的关键之一.     

甲泼尼龙琥珀酸钠治疗急性脊髓损伤近期副作用观察

目的探讨应用大剂量甲泼尼龙琥珀酸钠（甲强龙）治疗急性脊髓损伤（ASCI）的近期副作用。方法对42例急性脊髓损伤患者,根据受伤时间及本人意愿分为应用甲强龙的治疗组和未应用甲强龙的对照组,并观察其近期副作用。结果治疗组的肺部感染（9例）、泌尿系感染（10例）等副作用发生率明显升高,住院时间[（25．2±5．4）d]显著延长。结论大剂量应用甲强龙能增加肺部感染、泌尿系感染、消化道反应的发生率,但未增加手术切口感染发生率,这些副作用明显延长患者的住院时间,但未增加患者的病死率。     

高压氧治疗脊髓损伤：附10例报告

我院自1989年1月—1990年10月对20例外伤性脊髓损伤的病人随机分为高压氧及非高压氧治疗两组。其结果显示高压氧治疗组脊髓功能恢复明显,有肯定的疗效。治疗后及半年后随访。统计学资料显示有显著性差异(P<0.05)。一般认为治疗结果的好坏与损伤后治疗的早晚呈正相关。但本组病例治疗均较晚,仍取得较满意的结果。现就有关高压氧治疗外伤性脊髓损伤的机理、病例选择、疗效的判断等问题讨论如下: 资料与方法研究方法:患者为伤后入院的急性脊髓损伤的20例病人,不包括有生命危险的严重创伤者、妊娠者。入院时将患者随机分为高压氧治疗组10例与非高压氧治疗组10例。入院时,治疗     

高压氧联合甲基泼尼松龙早期治疗急性脊髓损伤

目的探讨早期应用高压氧联合甲基泼尼松龙治疗急性脊髓损伤的疗效,评估急性脊髓损伤早期高压氧联合甲基泼尼松龙治疗的临床意义。方法回顾性研究笔者所在神经外科2006-06～2009-12收治的脊髓损伤患者95例,所有患者均急诊给予减压、脊柱内固定术,按纳入标准随机分为高压氧组(HBO组)31例,甲基泼尼松龙组(MP组)32例和高压氧+甲基泼尼松龙组(HBO+MP组)32例。结果 HBO+MP组临床疗效优于HBO和MP组(P<0.05),MP组疗效优于HBO组(P<0.05)。结论早期给予高压氧联合甲基泼尼松龙治疗能有效促进脊髓功能恢复,降低致残率,显著改善患者生活质量。     

注射用鼠神经生长因子联合甲泼尼龙治疗急性脊髓损伤的临床效果观察

目的 研究注射用鼠神经生长因子联合甲泼尼龙治疗急性脊髓损伤的临床效果。方法 选择2013年5月-2017年5月在铜川市人民医院进行诊治的急性脊髓损伤患者60例,随机分为两组。两组均采取内固定术、椎管减压术、止血、抗炎以及脱水等常规治疗。对照组静脉滴注甲泼尼龙30 mg/kg,持续15 min后,再按照每小时5.4 mg/kg的剂量进行连续静脉滴注23 h,观察组联合肌内注射鼠神经生长因子进行治疗,每次30 μg,每天1次,两组均治疗2个月。比较两组的临床治疗效果,治疗前后的运动功能和感觉功能评分,独立性生活能力和日常生活能力评分,以及不良反应发生情况。结果 观察组的有效率为80.00%（24/30）,明显高于对照组的63.33%（19/30）,差异有统计学意义（P<0.05）。两组治疗后的运动功能以及感觉功能评分均明显升高,同组治疗前后比较差异有统计学意义（P<0.05）;且观察组明显高于对照组,差异有统计学意义（P<0.05）。两组治疗后的独立性生活能力以及日常生活能力评分均明显升高,同组治疗前后比较差异有统计学意义（P<0.05）;且观察组明显高于对照组,差异有统计学意义（P<0.05）。观察组的药物不良反应发生率为16.67%（5/30）,与对照组的20.00%（6/30）相比无明显差异。结论 注射用鼠神经生长因子联合甲泼尼龙治疗急性脊髓损伤的临床效果明显优于单独采用大剂量甲泼尼龙冲击治疗,可以有效改善患者的神经功能,提高生活能力,且安全性较高。     

大鼠急性脊髓损伤后血小板活化因子的变化及甲基强的松龙对其的影响

目的利用大鼠急性脊髓损伤（ASCI）模型探讨大剂量甲基强的松龙（MP）对脊髓神经组织中血小板活化因子（PAF）的影响。方法54只Wister大鼠分为3组：未损伤组（A组）6只,损伤后注射0．9％氯化钠溶液组（B组）24只,损伤后注射MP组（C组）24只。用Allen氏重物坠击法（WD）,以25g×10cm致伤力造成B脊髓损伤模型,C组分别于术后即刻经尾静脉按首次剂量30mg／kg注射MP,以后按5．4mg·kg^-1·h^-1,共23h,分4次静脉推注;B组在同时间点注入等量0．9％氯化钠溶液。分别于术后2、5、12、28d取血及3组损伤部位脊髓组织做PAF测定。结果脊髓受损后,血及损伤组织中PAF均明显增高（P〈0．05）,注射MP后,血清及受损脊髓组织中PAF含量均明显下降（P〈0．05）。结论大剂量MP可能通过抑制损伤脊髓组织中PAF的表达,来发挥其对受损脊髓神经细胞的保护作用。     

Population pharmacokinetics of methylprednisolone in accident victims with spinal cord injury

OBJECTIVE: High-dose methylprednisolone (MP) is used to treat acute spinal cord injury (ASCI). The objective of the present study was to determine the pharmacokinetics of the pro-drug methylprednisolone hemisuccinate (MPHS) and MP in accident victims with ASCI. METHODS: The patients (n = 26) were treated with a bolus intravenous loading dose of 30 mg/kg MPHS within 2 h after injury and this was followed by a maintenance infusion of 5.4 mg/kg/h up to 24 h. Blood, CSF and saliva samples were collected up to 48 h after the initial dose and the samples were analyzed by HPLC. Concentration-time data of MPHS and MP were analyzed using population pharmacokinetic analysis with NONMEM software. RESULTS: MPHS and MP could be monitored in plasma and CSF. MP but not MPHS was present in saliva. High variability was seen in the MPHS levels in CSF. The pharmacokinetics of the pro-drug and the metabolite were adequately described by a 2-compartment model with exponential distribution models assigned to the interindividual and the residual variability. At steady state, the average measured MP concentration in plasma was 12.3+/-7.0 microg/ml and 1.74+/-0.85 microg/ml in CSF. The CSF levels of MP could be modeled as a part of the peripheral compartment. CONCLUSION: This study demonstrated that CSF concentrations of MP were sufficiently high after i.v. administration and reflected the concentrations of unbound drug in plasma. Salivary levels of MP were about 32% of the plasma level and may serve as an easily accessible body fluid for drug level monitoring.     

依达拉奉对急性脊髓损伤后的大鼠神经组织氧化损害保护作

目的 探讨依达拉奉对急性脊髓损伤后的大鼠神经组织保护机制.方法 90只SD大鼠随机分为假手术组(n=30),ASCI对照组(n=30)和依达拉奉干预组(n=30),采用改良的Allen法,制成中度脊髓损伤大鼠模型;每组分别于6h、12h、24h、48h、72h5个时点,每个时点6只大鼠,检测各组各时点血清及脊髓中的NO、SOD、MDA的含量及脊髓组织含水量变化;TUNEL法检测72h后各组脊髓中的神经细胞凋亡及Caspase-3mRNA阳性细胞.结果 对照组各时点SOD活性明显低于假手术组,而NO、MDA含量明显高于假手术组,对照组各时点含水量与SOD活性呈明显负相关,与MDA含量呈明显正相关,依达拉奉干预组各时点SOD活性明显高于对照组,而NO、MDA含量明显低于对照组,依达拉奉干预组各时点含水量与SOD活性呈明显负相关,与MDA含量呈明显正相关,假手术组脊髓中无或偶见凋亡细胞及阳性染色细胞,对照组可见大量凋亡细胞及阳性染色细胞,依达拉奉干预组凋亡细胞及阳性染色细胞数量较对照组明显减少.结论 依达拉奉通过有效地清除氧自由基,可明显抑制急性脊髓损伤后的脂质过氧化反应及降低神经细胞的凋亡,从而达到保护其神经组织的作用.     

甲基强的松龙在颈椎后纵韧带骨化症围手术期应用的疗效

目的探讨甲基强的松龙(MP)在颈椎后纵韧带骨化症患者围手术期应用的效果。方法选择2004年1月至2007年1月在我院脊柱外科手术治疗的76例颈椎后纵韧带骨化症患者,其中49例行前路减压术,27例行后路减压术。根据围手术期用药情况将其分为2组,MP组38例,在脊髓减压前30min予MP1000mg,iv gtt,术后d 1、2、3给予MP 160 mg,30 min内iv gtt;地塞米松(Dex)组38例,术后d 1、2、3应用地塞米松20mg·d~(-1),iv gtt,d4减至10mg,d 5减至5mg,5 d后停用。应用美国脊髓损伤协会(ASIA)评分评价2组患者术前和术后神经功能情况。结果2组患者术后7d和3mo的评分均较术前明显提高(P<0.05);但MP组术后7d和3mo神经功能均优于Dex组(P<0.05)。Dex组2例患者术后出现一过性神经症状加重。2组均未出现消化道出血、切口感染等并发症。结论外科减压治疗颈椎后纵韧带骨化症是改善脊髓神经功能的有效方式,同时应用MP可有效维持减压后获得改善的脊髓神经功能。     

依达拉奉对脑梗死患者尿激酶溶栓后血清C-反应蛋白的影响

目的研究依达拉奉对脑梗死患者尿激酶溶栓后血清C．反应蛋白（CRP）水平的影响,探讨依达拉奉对溶栓后脑组织的保护作用。方法选取脑梗死患者41例随机分为两组,其中观察组19例,对照组22例。对照组给予尿激酶溶栓治疗,观察组在溶栓基础上给予依达拉奉静脉输入,每天2次,共用14d。治疗前后评估临床疗效和神经功能缺损积分,同时用免疫比浊法测定两组患者的血清CRP水平。结果治疗组神经功能缺损积分优于对照组（P〈0．05）,总有效率明显高于对照组（P〈0．01）,CRP水平较对照组明显降低（P〈0．05）。结论依达拉奉能明显改善急性脑梗死尿激酶溶栓的临床疗效,降低血清CRP水平,对脑梗死病情恢复和预后具有重要意义,依达拉奉可显著改善急性脑梗死患者的神经功能,保护缺血脑组织免受溶栓后代谢毒物的进一步损害。     

Early steroid withdrawal protocol with basiliximab, cyclosporine and mycophenolate mofetil in renal-transplant recipients

OBJECTIVE: Adverse effects of steroids have led to efforts to minimize their use in recipients of organ transplants. This study evaluated an early steroid withdrawal protocol including basiliximab, cyclosporine (CsA) and mycophenolate mofetil (MMF) in renal-transplant recipients. METHODS: Between January 2001 and April 2005, our early steroid withdrawal protocol was used in 130 patients who underwent renal transplantation. Immunosuppression consisted of CsA (6-8 mg/kg), MMF (2 g/kg) and methylprednisolone (MP); basiliximab was given as induction therapy (steroid withdrawal group). MP was administered in a dose of 500 mg or 250 mg at renal transplantation; thereafter, the dose was rapidly tapered and MP was withdrawn on day 14 post-transplant. RESULTS: The incidence of acute rejection in the steroid withdrawal group was similar to that in the conventional steroid treatment group (without basiliximab) (18% vs. 21%). The severity of rejection episodes was similar in the two groups. Patient and graft survivals were 100% and 97% in the steroid withdrawal group. In 80 of the 130 patients (62%) in the steroid withdrawal group, MP was successfully withdrawn, with good allograft function during follow-up. In the other 50 patients (38%), MP was reinitiated because of acute rejection or other reasons. The success rate of steroid withdrawal 12 months after transplantation in recipients of ABO-compatible grafts was significantly higher than that in recipients of ABO-incompatible grafts (66% vs. 44%). The dose of MMF during the 12 months after renal transplantation was significantly lower in steroid reinitiated group than in the successful withdrawn group (p<0.05). Patients in the successful withdrawn group showed metabolic benefits such as lower cholesterol levels as compared with the steroid reinitiated group. CONCLUSION: Although further follow-up is necessary to confirm our results, our protocol successfully permitted the early withdrawal of steroids in 62% of renal-transplant recipients, with no resumption of steroid treatment during 3 years of follow-up.     

多学科神经功能干预对缺血性脑卒中患者血清NSE、S100β、NPY及生活功能的影响研究

目的:研究多学科神经功能干预的实施方法及在缺血性脑卒中(CIS)护理中的应用价值.方法:将某院收治的84例CIS患者随机分为C组和C+S组各42例,C组实施常规护理,C+S组实施常规护理+多学科神经功能干预护理.于两组患者护理干预前后,分别检测神经功能指标(血清NSE、S100β、NPY)和生活功能指标(FMA量表、B...     

左卡尼汀佐治小儿肺炎支原体感染并心肌损害的疗效观察

目的:观察左卡尼汀佐治小儿肺炎支原体感染并心肌损害的疗效.方法:将65例肺炎支原体感染并心肌损害的患儿随机分为治疗组32例和对照组33例,对照组予以乳糖酸阿奇霉素10 mg/( kg·d)静脉滴注,3d为1个疗程,间隔4d应用第2个疗程,根据病情应用2～3个疗程,同时给予能量合剂及磷酸肌酸钠静脉滴注营养心肌治疗;治疗组加用左卡尼汀100 mg/(kg·d)口服,疗程14 d.结果:治疗后两组心肌酶各项指标均下降(P＜0.05),但治疗组心肌酶各项指标恢复情况优于对照组(P＜0.05),对照组谷草转氨酶、磷酸肌酸激酶、磷酸肌酸激酶同工酶、乳酸脱氢酶分别为(32.20±5.47) u/L、( 129.50±23.11) u/L、( 19.03±3.01) u/L、( 199.17±15.82) u/L,治疗组分别为(24.17±8.09) u/L、( 109.13±24.67) u/L、(16.90±3.27)u/L、(177.03±16.08) u/L;治疗组心电图恢复正常率为88.0％,优于对照组的66.7％( P＞0.05).结论:左卡尼汀治疗肺炎支原体感染并心肌损害有一定疗效.     

Long-term outcome of using allopurinol co-therapy as a strategy for overcoming thiopurine hepatotoxicity in treating inflammatory bowel disease

Background  Hepatotoxicity results in the withdrawal of thiopurines drugs, azathioprine (AZA) and mercaptopurine (MP), in up to 10% of patients with inflammatory bowel disease. Our group previously demonstrated that allopurinol with AZA/ciclosporin/steroid 'triple therapy' improved renal graft survival.
Aim  To confirm the hypothesis that allopurinol may alleviate thiopurine hepatotoxicity by similar mechanisms as proposed in our renal study.
Methods  Unselected patients with acute thiopurine hepatotoxicity were offered allopurinol co-therapy with low-dose AZA or MP. The starting AZA/MP dose was determined by thiopurine methyltransferase (TPMT) activity (two patients were intermediate TPMT); then this dose was reduced to 25% for allopurinol co-therapy. Response to treatment was assessed by clinical severity indices, endoscopy and blood tests.
Results  Of 11 patients (three Crohn's disease, eight ulcerative colitis) treated, nine (82%) remain in long-term remission (median 42 months) with normal liver tests. One patient also successfully bypassed flu-like symptoms. Two stopped: one nausea, one abnormal liver function (steatosis on biopsy). Leucopenia occurred in two cases and resolved with minor dose reductions.
Conclusions  Allopurinol co-therapy with low-dose AZA/MP can alleviate thiopurine hepatotoxicity. It appears safe and effective for long-term use, but requires monitoring for myelotoxicity. Assessing the TPMT activity helps tailor the AZA/MP doses.     

三联疗法治疗不稳定型心绞痛的疗效观察

目的:观察依诺肝素、氯吡格雷、阿司匹林联合治疗不稳定型心绞痛的疗效和安全性。方法:将2009年10月-2010年10月收治的100例不稳定型心绞痛患者随机均分为观察组和对照组。对照组给予阿司匹林起始剂量0.3g,之后0.1g,qd;氯吡格雷,负荷剂量300mg,然后75mg,qd,口服,6周为1个疗程。观察组在对照组基础上加用依诺肝素钠注射剂1mg·kg-1,q12h,皮下注射,持续应用3～7d。比较2组的治疗效果和不良反应发生情况。结果:观察组显效34例,有效15例,无效1例,总有效率为98.0%;对照组显效14例,有效22例,无效14例,总有效率为72.0%,2组总有效率比较差异有统计学意义(P<0.05)。观察组心绞痛复发、急性心肌梗死和心源性猝死等心脏事件的发生率显著低于对照组(P<0.05)。结论:依诺肝素、氯吡格雷、阿司匹林联合治疗不稳定型心绞痛疗效优于氯吡格雷、阿司匹林联合治疗,且不良反应比较无显著性差异。