大剂量甲基强的松龙冲击治疗急性脊髓损伤的疗效观察

目的:评估大剂量甲基强的松龙(MP)冲击对于治疗急性脊髓损伤(ASCI)患者神经功能恢复的影响,同时观察并发症。方法:本组ASCI患者共98例,年龄18～60岁,平均38.6岁。其中男性57例,女性41例。致伤原因为车祸或高空坠落,入院时受伤均不超过8小时。随机分为MP治疗组和对照组,其中MP治疗组62例,参照NASCISⅡ推荐方案,在持续心电监护下15分钟内经静脉快速滴注MP30mg/kg(冲击治疗),45分钟后继续给予MP5.4mg/kg/h,持续23小时。对照组36例未使用MP治疗,仅予地塞米松静滴。2组均予20%甘露醇脱水及洛赛克预防应急性溃疡治疗,随访6个月。采用美国ASIA分级标准评估2组患者治疗前后感觉及运动功能恢复情况。此外对2组并发症的发生率行统计学分析。结果:入院时确诊为不全性ASCI患者,伤后6周及随访6个月时,治疗组的感觉及运动功能改善情况显著优于对照组(P<0.01);入院时确诊为完全性ASCI患者,伤后6周及随访6个月时,治疗组的感觉及运动功能改善情况与对照组相比无统计学差异(P>0.05)。2组消化道溃疡、感染等并发症的发生率无统计学差异(P>0.05)。结论:对于ASCI合并不全瘫患者,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,同时消化道溃疡等并发症的发生率未增加。

Effects of High-Dose Methylprednisolone Therapy on Acute Spinal Cord Injury

Objective:To evaluate the recovery of motor function and the early complications in patients with acute spinal cord injury after receiving a high dose of methylprednisolone (MP) within 8 hours of injury. Materials and Methods:Ninety-eight patients were included in this study:62 in the MP group who were treated with MP within 8 hours of their injury according to the Second National Acute Spinal Cord Injury Study protocol,and 36 in non-MP group who were not administered with MP. Improvements in the American Spinal Injury Association motor score were compared between the MP group and the non-MP group. The complications within 6 weeks of high-dose MP therapy were compared with those of non-MP group. Results:Among the patients with incomplete paralysis at admission,the American Spinal Injury Association motor scores in the MP group were improved more significantly than those in the non-MP group at 6 weeks and 6 months follow up. Meanwhile,among the patients with complete paralysis at admission,the patients in the MP group did not show significantly more change in motor score than those in the non-MP group. The differences in complications between the 2 groups showed no statistical significance. Conclusion:MP should be administered to patients with incomplete spinal cord injury according to the Second National Acute Spinal Cord Injury Study protocol.