大剂量甲基强的松龙对急性脊髓损伤的疗效及预后判断

The Effect of High-dose Methylprednisolone in Patients of Acute Spinal Cord Injury and the Prognosis Estimating

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。

Objective To investigate the effect and complications of high-dose methylprednisolone （MP） in patients of acute spinal cord injury （ASCI） as well as to estimate the prognosis. Methods 38 cases of ASCI were c.assifled into slight,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-dose MP according to NASCIS H role. Then the effect and complications were analyzed,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 ASCl patients.