米乐松在急性脊髓损伤患者救治中应用:210例临床分析

Efficacy of methylprednisolone sodium succinate for treating 210 cases of acute spinal cord injury patients

目的探讨米乐松治疗急性脊髓损伤的临床疗效。方法回顾性分析上海市崇明区中心医院收治的210例急性脊髓损伤患者临床资料。急性脊髓损伤时间<3 h,根据患者体质量按照30.0 mg/kg体质量计算米乐松用量,于15 min内滴完;45 min后,按照5.4 mg/(kg·h)维持给药23 h。急性脊髓损伤时间3~8 h的患者,按照30.0 mg/kg体质量计算米乐松用量,于15 min内滴完;45 min后,按照5.4 mg/(kg·h)维持给药47 h。患者均予以泮托拉唑保护胃黏膜。患者治疗前后均进行JOA评分,评价米乐松治疗急性脊髓损伤的临床疗效。结果所有患者随访0.5~2.0年,平均0.8年。患者经米乐松冲击治疗后,均有不同程度的神经功能恢复。治疗前患者的JOA评分为(8.40±3.96)分,治疗后患者的JOA评分为(11.50±3.57)分,治疗后患者JOA评分优于治疗前,差异有统计学意义(P<0.05)。结论在急性脊髓损伤早期,使用大剂量的米乐松可以改善脊髓损伤患者的神经功能。

Objective To investigate the effect of the methylprednisolone sodium succinate for acute spinal cord injury. Methods A retrospective study was performed on 210 patients with acute spinal cord injury who were admitted in Shanghai Chongming District Central Hospital. Those early injured patients with acute spinal cord injury（ within 3 hours after injury） were injected with methylprednisolone sodium succinate at the dosage of 30. 0 mg/kg in 15 minutes,maintenaned at the dosage of 5. 4 mg/kg per hour after 45 minutes later four 23 hours. Those late injured patients with acute spinal cord injury（ within 8 hours after injury） were injected with methylprednisolone sodium succinate at the dosage of 30. 0 mg/kg in 15 minutes,maintenaned at the dosage of 5. 4mg/kg per hour after45 minutes later four 47 hours. All patients were treated with pantoprazole for the protection of gastric mucosa. All patients were scored according to JOA before and after the treatment,and the score was compared. Results All patients were followed up for at least0. 5 years（ 0. 5-2. 0 years averaged with 0. 8 years）. The outcome showed various degree of nerve function recovery in patient with spinal cord injury after evaluated by JOA（ P 〈 0. 05）. Conclusion Early use of large dosage of methylprednisolone sodium succinate can improve nerve function of spinal cord injury patients.