大剂量甲基泼尼松龙冲击及联合鞘内注射地塞米松治疗急性脊髓炎的疗效分析

发布时间：2018-04-03 17:37

本文选题：急性脊髓炎　切入点：鞘内注射　出处：《河北医科大学》2014年硕士论文

【摘要】：目的：急性脊髓炎(Acute Myelitis)是一种少见的散发性脊髓急性横贯性病变，目前病因尚不明确，无特效治疗。临床上大多采用大剂量甲基泼尼松龙冲击治疗，但效果不是很令人满意。该病预后差，致残率高，给患者及其家庭带来了严重的心理和经济负担。随着现代医学技术的发展和人们对生活质量要求的提高，急性脊髓炎的治疗效果已日趋引起人们的重视。本研究通过对大剂量甲基泼尼松龙冲击及联合鞘内注射地塞米松治疗急性脊髓炎的临床疗效的观察，旨在找到一种更加有效、经济且安全性高，能早期阻止病情进展并促进神经功能恢复的治疗方法，以减少急性脊髓炎患者的后遗症，降低致残率，改善预后，提高患者的生活质量。方法：本论文连续搜集了2005年10月至2013年11月在河北医科大学第二医院神经内科住院的106例急性脊髓炎患者。分析所有急性脊髓炎患者的病例资料，包括年龄、性别、临床症状和体征、影像学检查、脊髓病变情况、治疗方法等，选择其中给予大剂量甲基泼尼松龙冲击治疗及联合鞘内注射地塞米松治疗的患者各30例，分为对照组和治疗组。所有入选病例均符合急性脊髓炎国际协作组2012年制定的急性脊髓炎诊断标准，临床表现为病变平面以下双侧肢体瘫痪、传导束型感觉障碍和直肠膀胱功能障碍，并除外合并脑组织、视神经或周围神经损害的患者，除外由代谢性、血管性、压迫性或者放射性等因素导致的脊髓炎患者，除外合并有高血压、糖尿病、感染等不宜使用激素的患者。治疗组：给予甲基泼尼松龙500mg或1000mg加入0.9%氯化钠注射液中，缓慢静点，每三天甲基泼尼松龙量减半，减至60mg时改为口服醋酸泼尼松片，缓慢减量至停药，同时行腰椎穿刺术给予鞘内注射地塞米松5mg，每3-5天一次，每次5mg。对照组：给予甲基泼尼松龙500mg或1000mg加入0.9%氯化钠注射液中，缓慢静点，每三天减半，减至60mg时改为口服醋酸泼尼松片，缓慢减量至停药，未给予鞘内注射地塞米松治疗。动态监测两组患者的电解质、血压、血糖等，并给予营养神经、补钙、保护胃黏膜等常规治疗。观察分析患者的肌力、感觉、自主神经功能恢复情况，比较两组患者7d、14d、21d的治疗效果及不良反应和并发症的发生率是否有差别。使用SPSS17.0统计软件对数据进行统计学分析处理。计量资料以均数±标准差(x±S)表示，统计学差异分析选用t检验；计数资料选用Χ2检验；等级资料选用Wilcoxon秩和检验。P0.05为差异有统计学意义。结果： 1一般资料治疗组患者年龄12-63岁，平均年龄36.03±15.96岁；对照组患者年龄13-64岁，平均年龄35.60±16.67岁，两组之间年龄分布无明显差异（P0.05）。治疗组男性7例，女性23例，男女比例1:3.29；对照组男性9例，女性21例，男女比例1:2.33，两组之间性别构成无明显差异（P0.05）。治疗组9例患者表现为四肢瘫，21例患者表现为截瘫；对照组11例患者表现为四肢瘫，19例患者表现为截瘫，两组之间瘫痪程度无明显差异（P0.05）。治疗组中15例患者给予丙种球蛋白治疗，对照组中12例患者给予丙种球蛋白治疗，其差异无统计学意义（P0.05）。 2治疗组和对照组在7d、14d、21d治疗效果的比较 7d：治疗组治愈0例，显效3例，有效18例，无效9例，无死亡病例；对照组治愈0例，显效0例，有效14例，无效16例，无死亡病例。经两个独立样本的秩和检验，两组之间有统计学差异（P0.05），治疗组的治疗效果优于对照组。 14d：治疗组治愈0例，显效10例，有效16例，无效4例，无死亡病例；对照组治愈0例，显效4例，，有效20例，无效6例，无死亡病例。治疗组的治疗效果优于对照组，经两个独立样本的秩和检验，两组之间无统计学差异（P0.05）。 21d：治疗组治愈6例，显效11例，有效12例，无效1例，无死亡病例；对照组治愈1例，显效10例，有效16例，无效3例，无死亡病例。经两个独立样本的秩和检验，两组之间有统计学差异（P0.05），治疗组的治疗效果优于对照组。 3不良反应和并发症发生率的比较治疗组患者出现血糖升高2例，皮疹3例，压疮1例；对照组患者出现丘疹4例，血糖升高2例，肺部感染4例，泌尿系感染3例，压疮1例。治疗组不良反应和并发症的发生率（20%）低于对照组（46.7%），其差异有统计学意义（P0.05）。结论： 1治疗组和对照组在年龄分布、性别构成、瘫痪程度及应用丙种球蛋白的比例之间的比较无明显差异。 2治疗组在7d、14d、21d的治疗效果均优于对照组，但经两个独立样本的秩和检验分析，其中在7d、21d时两组之间的差异有统计学意义，而在14d时两组之间的差异无统计学意义。考虑可能与样本量小，观察时间短，疗效标准受主观因素干扰，统计数据可能存在偏差有关，有待于扩大样本量反复多次进行进一步研究论证。但总体看来，联合鞘内注射地塞米松治疗的效果更好。 3治疗组不良反应和并发症的发生率低于对照组，其差异有统计学意义。考虑可能与联合治疗使神经功能缺损恢复快，早期疗效好，治疗时间短，主动运动增多，尿管保留时间缩短等有关。
[Abstract]:Objective : Acute Myasthenia is a rare and sporadic acute transverse lesion of the spinal cord . The cause of the disease is not clear and has no special effect . The clinical curative effect of this study is not satisfactory . With the development of modern medical technology and the improvement of the quality of life , the treatment effect of acute mycitis has become more and more important .

Methods : A total of 106 patients with acute mycitis admitted to the Second Affiliated Hospital of Hebei Medical University from October 2005 to November 2013 were collected , including age , sex , clinical symptoms and signs , imaging examination , spinal cord pathological condition , treatment method and so on . Statistical difference analysis selects t test ;
The counter data shall be tested by X - ray 2 ;
Wilcoxon rank sum test was used in the grade data , and the difference was statistically significant .

Results :

1 General information

The age of patients in the treatment group was 12 - 63 years , the mean age was 36.03 卤 15.96 years .
In the control group , the age ranged from 13 to 64 years , the mean age was 35.60 卤 16.67 years , there was no significant difference between the two groups ( P0.05 ) .
There was no significant difference between the two groups ( P0.05 ) .
In the control group , 11 patients showed limbs paralysis , 19 cases were paraplegic , there was no significant difference between the two groups ( P0.05 ) . 15 patients in the treatment group were treated with gamma globulin , 12 of the control group were treated with gamma globulin , and the difference was not statistically significant ( P0.05 ) .

Comparison of therapeutic effect between treatment group and control group on 7d , 14d and 21d

7d : 0 cases were cured in the treatment group , 3 cases were markedly effective , 18 cases were effective , 9 cases were ineffective and no death cases were reported ;
In the control group , 0 cases were cured , 0 cases were markedly effective , 14 cases were effective , 16 cases were ineffective and no death cases were reported . There was statistical difference between the two groups after two independent samples ( P0.05 ) . The treatment effect of the treatment group was better than that of the control group .

14 days : 0 cases were cured in the treatment group , 10 cases were markedly effective , 16 cases were effective , 4 cases were ineffective and no death cases were reported ;
In the control group , 0 cases were cured , 4 cases were markedly effective , 20 cases were effective , 6 cases were ineffective and no death cases were found . The treatment effect of the treatment group was better than that of the control group . There was no statistical difference between the two groups after the rank sum test of the two independent samples ( P0.05 ) .

21 days : 6 cases were cured in the treatment group , 11 cases were markedly effective , 12 cases were effective , 1 case was ineffective and no death cases were reported ;
In the control group , 1 case was cured , 10 cases were markedly effective , 16 cases were effective , 3 cases were ineffective and no death cases were reported . There was statistical difference between the two groups after two independent samples ( P0.05 ) , and the treatment effect of the treatment group was better than that of the control group .

3 Comparison of the incidence of adverse reactions and complications

In the treatment group , there were 2 cases of elevated blood glucose , 3 cases of rash and 1 case of pressure ulcer ;
In the control group , there were 4 cases of papules , 2 cases of hyperglycemia , 4 cases of pulmonary infection , 3 cases of urinary system infection , 1 case of pressure ulcer . The incidence rate of adverse reactions and complications in the treatment group ( 20 % ) was lower than that in the control group ( 46.7 % ) , and the difference was significant ( P0.05 ) .

Conclusion :

There was no significant difference between treatment group and control group in age distribution , gender composition , degree of paralysis and the proportion of immunoglobulin .

There was no significant difference between the two groups at 7 d , 14 d and 21 d after 7 d , 14 d and 21 d , but there was no significant difference between the two groups at 7 d and 21 d .

3 . The incidence of adverse reactions and complications in the treatment group was lower than that of the control group , and the difference was statistically significant . Considering the possibility of the combination therapy , the nerve function defect could be recovered quickly , the early curative effect is good , the treatment time is short , the active motion is increased , the retention time of the urine tube is shortened , and the like .

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R744.3

【引证文献】