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[急性脊髓损伤]2002年.Steroids for acute spinal cord injury

 

Background  Acute spinal cord injury is a devastating condition typically affecting young people, mostly males. Steroid treatment in the early hours after the injury is aimed at reducing the extent of permanent paralysis during the rest of the patient's life.

Objectives  To review randomized trials of steroids for acute spinal cord injury. Search strategy The review draws on the search strategy developed by the Cochrane Injuries Group. In addition, _les of the National Acute Spinal Cord Injury Study have been reviewed and a MEDLINE search conducted. Selection criteria All published or unpublished randomized controlled trials of steroid treatment for acute spinal cord injury in any language. Data collection and analysis Data have been abstracted from original trial reports.

For the NASCIS, Japanese and French trials, additional data (e.g. SDs) have been obtained from the original authors. Main results There are few trials in this area. Only one steroid has been extensively studied, methylprednisolone sodium succinate, which has been shown to improve neurologic outcome up to one year post-injury if administered within eight hours of injury and in a dose regimen of: bolus 30mg/kg over 15 minutes, with maintenance infusion of 5.4 mg/kg per hour infused for 23 hours. The initial North American trial results were replicated in a Japanese trial but not in one from France. Data was obtained from the latter studies to permit appropriate meta-analysis of all three trials.

This indicated signi_cant recovery in motor function after methylprednisolone therapy, when administration commenced within eight hours of injury. A more recent trial indicates that, if methylprednisolone therapy is given for an additional 24 hours (a total of 48 hours), additional improvement in motor neurologic function and functional status are observed. This is particularly observed if treatment cannot be started until between three to eight hours after injury. The same methylprednisolone therapy has been found effective in whiplash injuries. A modi_ed regimen was found to improve recovery after surgery for lumbar disc disease.

 

 


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