大剂量甲强龙治疗急性脊髓损伤后早期并发症的研究

Early complications of high-dose methylprednisolone in acute spinal cord injury patients

[目的]探讨应用大剂量甲基强的松龙治疗急性脊髓损伤后的早期并发症及其对神经系统功能恢复的影响。[方法]回顾分析本院2003年1月～2012年12月收治的80例急性脊髓损伤的患者，按是否应用甲强龙治疗分为甲强龙组和非甲强龙组，记录并分析治疗前后两组患者的年龄、性别、格拉斯哥昏迷评分（GCS）、APACHEⅡ、损伤严重度评分（ISS）、神经功能Frankel分级以及出现高血糖、呼吸系统感染、泌尿系感染、伤口感染等早期并发症的差异。[结果]两组患者之间神经系统功能的恢复无显著差异。甲强龙组的呼吸系统感染率及总感染率高于非甲强龙组；同时，甲强龙组高血糖的发病率较对照组显著增高。而两组患者在菌血症、泌尿系感染或伤口感染方面没有显著差异。[结论】应用大剂量甲基强的松龙对急性脊髓损伤患者的预后及神经功能的恢复早期没有明显促进作用，反而增加了感染和代谢性疾病等早期并发症的风险。

[ Objective] To investigate the early complications and effect on neurological outcome of methylprednisolone （MP） treatment in spinal cord injury （SCI） patients in the acute phase. [ Method] A retrospective analysis of 80 acute spinal cord injury patients admitted to our hospital from January 2003 to December 2012 was made. Patients were divided to MP group and no -MP group according to the medical treatment received. The age, gender, Glasgow coma -ore sc （GCS）, APACHE II, injury severity score （ISS）, nerve function Frankel grade and early high blood glucose, respiratory tract, urinary tract or wound infections and other complications were record and analyzed. [ Result] There was a significant increase in the incidence of hy- perglycemia in the MP group. There were no differences between both groups in neurological function discharge. MP group pres- ented an increase in respiratory tract infections and in total infections compared to no - MP group. There was a significant in- crease in the incidence of hyperglycaemia in the MP group. There was no difference in sepsis, urinary tract infection or wound in- fection between the two groups. [ Conclusion] There is no significant improvement in prognosis and nerve function recovery after using high - dose methylpredniselone early in acute spinal cord injury. In addition, the risk of infection and metabolic disease complications increases.