Bernhard Michael, Gries André, Kremer Paul, Böttiger Bernd W
Department of Anesthesiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.
Resuscitation. 2005 Aug;66(2):127-39. doi: 10.1016/j.resuscitation.2005.03.005.
Up to 20,000 patients annually suffer from spinal cord injury (SCI) and 20% of these die before being admitted to the hospital in the United States as well as in the European Union. Prehospital management of SCI is of critical importance since 25% of SCI damage may occur or be aggravated after the initial event. Prehospital management includes examination of the patient, spinal immobilisation, careful airway management (intubation, if indicated, using manual in-line stabilisation), and cardiovascular support (maintenance of mean arterial blood pressure above 90 mm Hg) and blood glucose levels within the normal range. It is still not known whether additional specific therapy is useful. Studies have not demonstrated convincingly that methylprednisolone (MPS) or other pharmacological agents really have clinically significant and important benefits for patients suffering from SCI. Recently published statements from the United States also do not support the therapeutic use of MPS in patients suffering from SCI in the prehospital setting any more. Moreover, at this stage, it is not known whether therapeutic hypothermia or any further pharmacological intervention has beneficial effects or not. Therefore, networks for clinical studies in SCI patients should be established, as a basic requirement for further improvement in outcome in such patients.
在美国和欧盟，每年多达20000名患者遭受脊髓损伤（SCI），其中20%在入院前死亡。SCI的院前管理至关重要，因为25%的SCI损伤可能在初始事件后发生或加重。院前管理包括对患者进行检查、脊柱固定、仔细的气道管理（如有指征，使用手动轴向固定进行插管）、心血管支持（将平均动脉血压维持在90毫米汞柱以上）以及将血糖水平维持在正常范围内。目前尚不清楚额外的特异性治疗是否有用。研究尚未令人信服地证明甲基强的松龙（MPS）或其他药物对SCI患者确实具有临床显著且重要的益处。美国最近发表的声明也不再支持在院前环境中对SCI患者使用MPS进行治疗。此外，目前尚不清楚治疗性低温或任何进一步的药物干预是否有有益效果。因此，应建立SCI患者临床研究网络，这是进一步改善此类患者预后的基本要求。
