纳洛酮治疗急性脊髓损伤的临床观察

Clinical Observation of Naloxone in the Treatment of Acure Spinal Cord Injury

作者以甲基强的松龙为参照，观察了１４例急性脊髓损伤患者应用纳洛酮后的神经功能恢复。结果表明，急性脊髓损伤６ｈ内的患者，入院后即在１５ｍｉｎ内通过外周静脉滴注纳洛酮５．４μｇ／ｋｇ，暂停４５ｍｉｎ后以４μｇ／ｋｇ／ｈ维持２３ｈ。给药后６周观察，同对照组相比，纳洛酮治疗患者的触觉、痛觉评分明显提高，同对照组相比，甲基强的松龙组给药后６周及６月观察，运动功能、触觉、痛觉功能评分均显著提高。结论：急性脊髓损伤后６ｈ内外周静脉给予纳洛酮也可改善急性脊髓损伤患者的神经功能，但作用不如甲基强的松龙显著。

We evaluated the efficacy and safety of naloxone and methylprednisolone for treatment of acute spinal cord injury.All the patients were treated within 6 hours of injury.Naloxone was given to 14 patients as a bolus of 5 4 ug per kilogram of body weight,followed by infusion at 4 0 ug per kilogram per hour for 23 hours.Methylprednisolone was give to 16 patients as a bolus of 30 ug per kilogram of body weight,followed by infusion at 5 4 ug per kilogram per hour for 23 hours.Placebos were given to 16 patients by bolus and infusion.Motor and sensory functions were assessed by systematic neurologic examination on admission and six weeks and six months after injury.After six weeks the pationts who were treated with naloxone had significant improvement as compared with those given placebo in sensation to pinprick and touch,but in motor function.After six months the patients who were treaed with naloxone had significant improvement in motor function and sensation to pinprick and touch.After six weeks,six months the patients who were treated with methylprednisolone had significant improvement as compared with those given placebo.We conclude that in patients with acute spinal cord injury,treatment with both naloxone and methylprednisolone in the dose used in this study improves neurologic recovery when the medication is given in the first six hours.