甲泼尼龙联合亚低温治疗急性脊髓损伤

Methylprednisolone Combined with Mild Hypothermia therapy in the Treatment of Acute Spinal Cord Injury

目的探讨甲泼尼龙冲击联合亚低温疗法在急性脊髓损伤治疗中的临床价值。方法 2013年1月至2014年8月期间于我院就诊的急性脊髓损伤患者70例,按照入院顺序随机分为两组,各35例。全部患者均给予脱水、对症支持治疗以及常规预防应激性溃疡。对照组受伤后3 h内给予甲泼尼龙冲击治疗,观察组在对照组的基础上联用亚低温疗法,对比两组患者治疗前后神经功能评分及白细胞介素-6(interleukin 6,IL-6)、白细胞介素-8(interleukin 6,IL-8)、肿瘤坏死因子-α(tumor necrosis factorα,TNF-α)水平变化,并发症发生情况等。结果治疗后2周、1、3、6、12个月,两组患者的ASIA神经功能评分有不同程度提高,其中观察组的运动、针刺、触觉评分优于对照组,差异具有统计学意义(P<0.05);治疗后,机体内IL-6、IL-8、TNF-α水平逐渐降低,观察组各项指标水平降低速度较快,较对照组显著(P<0.05);观察组患者的不良反应发生率略低于对照组,但差异不具有统计学意义(P<0.05)。结论甲泼尼龙冲击联合亚低温治疗急性脊髓损伤可以减少炎症因子的释放,促进神经功能的恢复,值得临床推广。

Objective To investigate the clinical value of methylprednisolone combined with mild hypothermia therapy in the treatment of acute spinal cord injury. Methods 70 patients with acute spinal cord injury were randomly divided into two groups according to the order of admission in1 /2013 ~ 8 /2014,and 35 cases each. All patients were given dehydration,symptomatic support treatment and conventional inhibitors. The control group were given methylprednisolone after 3 hours of injury,and the mild hypothermia therapy were applied in addition to the treatment of the control group. We compared the neurological function score,changes of IL-6,IL-8,TNF-a,and complications between the two groups. Results After 2W,1,3,6,12 months of treatment,ASIA neurological function score in each group had a different degrees improvement,the exercise,acupuncture,tactile score of observation group were better than that of control group and showed a statistically difference（ P〈0. 05）; After treatment,the levels of IL-8,TNF-a and IL-6 were decreased,and the levels of the observation group were significantly lower than those in the control group（ P〈0. 05）. The incidence of adverse reactions in observation group was lower than that in control group,but the difference was not statistically significant（ P〈0. 05）. Conclusion methylprednisolone impact combined with mild hypothermia has a good clinic in acute spinal cord injury,that can reduce the release of inflammatory factors,promote the recovery of neural function,is worth the clinical promotion.