急性颈椎颈髓损伤后呼吸道管理

颈髓的解剖和生理与呼吸功能关系密切,颈椎、颈髓损伤后,呼吸功能会受到不同程度的影响,而高位颈髓损伤对呼吸功能的影响更大.因此,加强颈椎、颈髓损伤病人呼吸道的管理,改善通气功能尤为重要.作者对此进行了综述,旨在提高对此类病人呼吸道管理的水平,促进康复.     

颈髓损伤合并重度颅脑损伤的早期诊治

颅颈复合伤在临床上并非罕见,但由于颅脑损伤造成的神经功能障碍可掩盖颈髓损伤的临床表现,早期的诊断及治疗较困难。１９９３年６月至１９９８年３月我科共收治合并重度颅脑损伤的颈髓损伤９例,占同期重度脑损伤的０．８７％（９／１０３４）。报告如下。１临床资料１...     

急性颈髓损伤1H-MRS与MRI的对照研究

目的对照研究磁共振质谱(1H-MRS)与MRI对急性颈髓损伤的诊断价值.方法根据19例急性颈髓损伤患者的MRI表现,分为脊髓正常信号组(损伤组Ⅰ)和脊髓异常信号组(损伤组Ⅱ),并以9例健康者作对照.进行1H-MRS检查,并计算氮-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、乳酸(Lac)波峰面积,分析NAA/Cho、NAA/Cr、Cr/Cho、Lac/Cho.结果损伤组Ⅰ与对照组比,仅Lac/Cho值升高(P＜0.05).损伤组Ⅱ与对照组比,NAA/Cho、NAA/Cr值降低,Lac/Cho值升高(P＜0.01).损伤组Ⅱ较损伤组Ⅰ NAA/Cho、NAA/Cr显著减低(P＜O.05).结论1H-MRS可定量测定创区颈髓相关代谢介质的变化,从代谢水平反映颈髓损伤的不同程度.MRI结合1H-MRS更有利于颈髓损伤评价.     

颈髓损伤漏诊原因分析及预防

我院自１９９４．１～２００１．３，共收治颈髓损伤２０７例，其中合并有脑挫伤、胸腹腔脏器损伤或骨盆骨折等按AIS－LSS评分［１］属于严重复合伤病例６０例。２０７例中漏诊１０例，其中９例合并严重复合伤。因此如何避免严重复合伤中颈髓损伤的漏诊是一个重要的问题。临床资料１．一般资料：２０７例颈髓损伤根据临床症状，颈椎CT或颈髓核磁共振确诊。其中男性１９２例，女性１５例；年龄１５～６６岁，平均３７岁；受伤原因：交通事故伤１３０例，高处坠落伤５０例，压伤１５例，其它伤５例。２．合并伤情况：合并有脑挫伤１５例，…     

急性颈髓损伤与神经恶化

急性颈髓损伤并发症较多、死亡率高，特别是泌尿系感染、褥疮、肺部感染、呼吸衰竭、深静脉栓塞、肺栓塞是常见致死的原因。近年来对伤后神经恶化逐渐认识，文献报告发生率高达10％。自1997年1月～2002年6月收治的89例急性颈髓损伤后有11例出现神经恶化，本文加以分析总结。     

颈髓损伤后的神经恶化

目的：分析颈髓损伤后的病人出现神经恶化的原因,为临床治疗提供依据。方法：对２９５例颈髓损伤病人的临床资料进行分析,共有８例神经恶化,将其分为术前、术后及保守治疗３组,进一步分析引起神经恶化的原因。结果：颈椎颈髓损伤后神经恶化发生率为２．７％,恶化病人的死亡率为６２．５％。伤后５日之内手术和使用Ｈａｌｏ－Ｖｅｓｔ固定颈椎时出现的机械性不稳与神经恶化密切相关。结论：早期外科手术、Ｈａｌｏ－ｖｅｓｔ牵引     

无骨折脱位颈髓损伤的临床治疗

1996—2001年，我院在颈髓损伤的治疗中，收治无骨折脱位的颈髓损伤患者24例。由于此类患者X线检查无明显骨折脱位以及对该病的认识和经验不足，较易造成漏诊、误诊，治疗效果常不够理想。本文就对该病的临床诊断、治疗和发病机制作一探讨，报告如下。     

血小板活化因子对颈髓损伤后ATP酶活性及颈髓水肿的影响

采用Ａｌｅｎ打击法造成Ｃ６，７损伤，采用鞘内注射血小板活化因子（ＰＡＦ）及静脉注射ＰＡＦ受体拮抗剂ＢＮ５２０２１，观察其对颈髓组织ＡＴＰ酶活性、离子含量、含水量的影响。结果显示，ＰＡＦ能够增加颈髓损伤后颈髓组织含水量、Ｎａ＋、Ｃａ２＋含量，抑制Ｃａ２＋－Ｍｇ２＋ＡＴＰ酶、Ｎａ＋－Ｋ＋ＡＴＰ酶活性，降低伤后颈髓组织Ｋ＋、Ｍｇ２＋含量；ＢＮ５２０２１能够降低伤后颈髓组织含水量，维持Ｃａ２＋－Ｍｇ２＋ＡＴＰ酶、Ｎａ＋－Ｋ＋ＡＴＰ酶活性、Ｎａ＋、Ｋ＋、Ｃａ２＋、Ｍｇ２＋的相对稳定，提示ＰＡＦ及其受体在颈髓损伤后颈髓水肿的病理生理过程中起重要作用，ＰＡＦ受体拮抗剂能够有效地减轻外伤性颈髓水肿。     

颈前路减压治疗外伤性颈髓损伤

颈前路减压治疗外伤性颈髓损伤河北医科大学第三医院（０５００５１）张英泽，潘进社，彭阿钦，吴希瑞，赵昌平，张煜，李衡，吴春生，刘彦辉，仝吉庆自１９９２年３月～１９９６年８月，我院应用颈前路减压治疗颈椎骨折脱位与急性颈椎间盘突出引起的颈髓损伤３８例，效果...     

Monocyte chemoattractant protein-1 level in serum of patients with acute spinal cord injury

Spinalcordinjury(SCI)withinthefirstfewhours,isfrequentlycomplicatedbyinflammatorymechanisms,includingtheinfluxofmonocyte/macrophagesaswellastheactivationofresidentspinalmicrogliaandastrocytes.Numerousstudieshave suggestedthattheinitialinfiltrationofthe hematogenouscellsmaybeduetothesecretionof cytokinesandchemokinesintheinjuredcentral nervoussystem(CNS),amongwhichmonocyte chemoattractantprotein1(MCP1),amemberofβfamilychemokines,isthemostwellrecognized.Studiesconductedinmanylaboratorieshave…     

急性脊髓损伤模型大鼠血清和脊髓的代谢组学研究

目的:采用~1H NMR核磁共振代谢组学的方法研究急性脊髓损伤模型大鼠的代谢组学特征及生物标志物,探讨核磁共振代谢组学应用于脊髓损伤研究的可行性。方法:取8周龄清洁级雄性SD大鼠20只,体重(200±10)g,按照随机数字法分为假手术组和模型组,每组10只,模型组采用改良的Allens法制作急性脊髓不完全损伤模型,假手术组不损伤脊髓,术后第1、5、7天采用BBB运动功能评分法进行行为学观察,术后第7天收集脊髓组织作病理学观察,核磁共振代谢组学对两组大鼠血清和脊髓样本进行代谢组学分析。结果:BBB评分显示假手术组术后后肢运动无明显改变,各时间点差异无统计学意义,模型组大鼠术后双下肢呈迟缓性瘫痪,BBB运动评分较低,各时间点差异存在统计学意义,两组运动功能评分在各时间点的差异均有统计学意义;病理切片显示假手术脊髓结构正常,神经分布均匀,模型组脊髓组织结构紊乱,神经元数目减少,存在炎性细胞浸润和空腔坏死组织。代谢组学分析表明,血清中极低密度脂蛋白(VLDL)、低密度脂蛋白(LDL)、谷氨酰胺(glutamine)、柠檬酸(citrate)、二甲基甘氨酸(DMG)等物质和脊髓中谷胱甘肽(glutathione)、3-羟基丁酸(3-OH-butyrate)、N-乙酰天冬氨酸(NAA)、磷酸胆碱(GPC)、谷氨酸(glutamate)、抗坏血酸(ascorbate)等物质浓度有明显变化(P0.05)。结论 :通过对假手术组和模型组大鼠血清和脊髓样本进行代谢组学检测和分析得到了两组样本的差异性代谢物质,有助于解释急性脊髓损伤后血清和脊髓组织中的特异性小分子物质的变化规律,为后期针对性地研究这些代谢标记物在急性脊髓损伤中的作用提供研究基础。     

脊柱脊髓损伤患者低钠血症的临床研究

目的：探讨脊柱脊髓损伤患者低钠血症的临床发病情况、发生机制及治疗措施。方法：回顾性分析543例急性脊柱脊髓损伤患者的临床资料。结果：543例患者中发生低钠者202例，占全部病例的37．2％。脊柱脊髓损伤患者低钠血症的发生率与患者脊髓损伤平面和程度有关。202例低钠者中13例出现神经精神症状。结论：脊柱脊髓损伤患者低钠血症的发生与钠盐摄入量减少、过量水负荷、脊髓损伤后肾脏排水保钠能力下降等原因有关。ASIA运动评分与脊柱脊髓损伤患者低钠血症的发生有相关性。     

Prevalence of metabolic syndrome in veterans with spinal cord injury

Context/Objective: Recent literature would suggest the prevalence of metabolic syndrome in persons with spinal cord injury (SCI) is higher than that of the general population, although no large cohorts have yet been reported. Part of the controversy relates to the differing definitions provided for metabolic syndrome and the characterization of obesity in persons with SCI.

Design/Participants: The current retrospective investigation represents a cross-sectional cohort of 473 veterans with SCI from a single center in the mid-Atlantic region of the United States for whom modified International Diabetes Federation (IDF) criterion variables for the metabolic syndrome were available in the computerized personal record system (CPRS).

Outcome Measures: These variables included a surrogate marker of obesity appropriate to SCI (Body Mass Index (BMI) ≥ 22?kg/m²), as well as indicators of diabetes, dyslipidemia and hypertension.

Results: Over 57% of the veterans assessed were determined to have metabolic syndrome by modified IDF criteria, including 76.7% with BMI ≥ 22?kg/m², 55.1% with or under treatment for hypertension, 49.7% with or previously diagnosed with diabetes mellitus, and 69.7% with or under treatment for high density lipoprotein (HDL) cholesterol under 40?mg/dl.

Conclusion: Metabolic syndrome and its constituent components appear to be more prevalent in veterans with SCI than in the general population, suggesting a greater need for identification and treatment interventions in this specialty population.     

脊髓损伤后的高凝状态

目的:观察脊髓损伤患者凝血系统的变化。方法:以20例符合条件的脊髓损伤病人为研究对象,分别于伤后2~6h、伤后1、3、5d采集病人股静脉血,测定血浆凝血酶抗凝血酶Ⅲ复合物(TAT)、凝血酶原片段1 2(F1 2)和D-二聚体(D-dimer)浓度;同时测定20名健康献血员TAT、F1 2、D-dimer血浆浓度作为正常对照。结果:正常对照组TAT、F1 2和D-dimer血浆浓度分别为3.1±0.9ng/ml、0.9±0.2nmol/l和42.6±9.3ng/ml。20例脊髓损伤病人伤后2~6hTAT、F1 2、D-dimer血浆浓度即显著增高(P<0.05),分别达45.3±14.2ng/ml、4.1±0.7nmol/l和136.2±14.3ng/ml,伤后1、2d内仍明显高于对照组,伤后3、4d趋于正常。结论:脊髓损伤后可激活凝血系统,造成高凝状态,这种高凝状态于伤后数小时即可发生,且持续存在2~3d。     

高血糖对急性脊髓损伤后果的影响

目的探讨给予高渗糖对急性脊髓损伤后神经学功能恢复的影响。方法将16只健康禁食的大白兔随机分为两组,采用Alien’s脊髓损伤模型,在脊髓损伤前一组动物接受50％高渗糖0．5g／kg体重（处理组）,另一组采用等容量生理盐水对照（对照组）,脊防损伤前后采股动脉血测定血糖并于损伤后3天进行神经学评分。结果处理组与对照组相比,血糖水平显著增高（P＜0．04）,72小时后的神经功能评分也明显不如对照组（P＜0．01）。结论急性脊髓损伤期间的高血糖可加重脊髓继发性损伤。     

Osteoporosis after spinal cord injury.

Dual-photon absorptiometry characterized bone loss in males aged less than 40 years after complete traumatic paraplegic and quadriplegic spinal cord injury. Total bone mass of various regions and bone mineral density (BMD) of the knee were measured in 55 subjects. Three different populations were partitioned into four groups: 10 controls (healthy, age matched); 25 acutely injured (114 days after injury), with 12 reexamined 16 months after injury; and 20 chronic (greater than 5 years after injury). Significant differences (p less than 0.0001) in bone mass mineral between groups at the arms, pelvis, legs, distal femur, and proximal tibia were found, with no differences for the head or trunk. Post hoc analyses indicated no differences between the acutely injured at 16 months and the chronically injured. Paraplegic and quadriplegic subjects were significantly different only at the arms and trunk, but were highly similar at the pelvis and below. In the acutely injured, a slight but statistically insignificant rebound was noted above the pelvis. Regression techniques demonstrated early, rapid, linear (p less than 0.0001) decline of bone below the pelvis. Bone mineral loss occurs throughout the entire skeleton, except the skull. Most bone loss occurs rapidly and below the pelvis. Homeostasis is reached by 16 months at two thirds of original bone mass, near fracture threshold.     

The impact of acute management on the occurrence of medical complications during the specialized spinal cord injury acute hospitalization following motor-complete cervical spinal cord injury

Context/Objective: Determine the impact of early admission and complete perioperative management in a specialized spinal cord injury (SCI) trauma center (SCI-center) on the occurrence of medical complications following tetraplegia.

Design: A retrospective comparative cohort study of prospectively collected data involving 116 individuals was conducted. Group 1 (N=87) was early managed in a SCI-center promptly after the trauma, whereas Group 2 (N=29) was surgically and preoperatively managed in a non-specialized (NS) center before being transferred to the SCI-center. Bivariate comparisons and multivariate logistic regression analyses were used to assess the relationship between the type of acute care facility and the occurrence of medical complications. Length of stay (LOS) in acute care was also compared.

Setting: Single Level-1 trauma center.

Participants: Individuals with acute traumatic motor-complete cervical SCI.

Interventions: Not applicable

Outcome measures: The occurrence of complications during the SCI-center stay.

Results: There was a similar rate of complications between the two groups. However, the LOS was greater in Group 2 (p=0.04). High cervical injuries (C1-C4) showed an important tendency to increase the likelihood of developing a complication, while high cervical injuries and increased trauma severity increased the odds of developing respiratory complications.

Conclusion: Although complication rates were similar in non-specialized and specialized centers, peri-operative management in a non-specialized center required a longer length of stay. Prompt transfer to a SCI-center may optimize the care trajectory by favoring earlier transfer to rehabilitation.     

脊髓损伤后膀胱尿流动力学检查及分类

目的：检测脊髓损伤患者膀胱功能并分类。探讨并发症与膀胱功能的关系。方法：采用尿流动力学四导程测压仪对３６例脊髓损伤患者进行下尿路功能分组检测。结果：各组患者因脊髓损伤节段及程度的不同，会有不同的尿流动力学表现及不同的膀胱功能，而且有相应的并发症发生，这之间有一定的规律及内在联系，并据此将膀胱分为三类。结论：根据尿流动力学表现对脊髓损伤后膀胱进行分类，对临床有一定的指导意义。