Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami, Miller School of Medicine, Miami, Florida, USA.
Neurosurgery. 2010 Apr;66(4):670-7. doi: 10.1227/01.NEU.0000367557.77973.5F.
Although a number of neuroprotective strategies have been tested after spinal cord injury (SCI), no treatments have been established as a standard of care.
We report the clinical outcomes at 1-year median follow-up, using endovascular hypothermia after SCI and a detailed analysis of the complications.
We performed a retrospective analysis of American Spinal Injury Association and International Medical Society of Paraplegia Impairment Scale (AIS) scores and complications in 14 patients with SCI presenting with a complete cervical SCI (AIS A). All patients were treated with 48 hours of modest (33 degrees C) intravascular hypothermia. The comparison group was composed of 14 age- and injury-matched subjects treated at the same institution.
Six of the 14 cooled patients (42.8%) were incomplete at final follow-up (50.2 [9.7] weeks). Three patients improved to AIS B, 2 patients improved to AIS C, and 1 patient improved to AIS D. Complications were predominantly respiratory and infectious in nature. However, in the control group, a similar number of complications was observed. Adverse events such as coagulopathy, deep venous thrombosis, and pulmonary embolism were not seen in the patients undergoing hypothermia.
This study is the first phase 1 clinical trial on the safety and outcome with the use of endovascular hypothermia in the treatment of acute cervical SCI. In this small cohort of patients with SCI, complication rates were similar to those of normothermic patients with an associated AIS A conversion rate of 42.8%.
尽管已经有许多神经保护策略在脊髓损伤（SCI）后进行了测试，但没有一种治疗方法被确立为标准治疗方法。
我们报告了 1 年中位数随访时的临床结果，使用 SCI 后的血管内低温和对并发症的详细分析。
我们对 14 名完全性颈段 SCI（AIS A）的 SCI 患者进行了回顾性分析，记录了美国脊髓损伤协会和国际截瘫医学学会损伤评分（AIS）以及并发症。所有患者均接受 48 小时适度（33 摄氏度）血管内低温治疗。对照组由在同一机构接受治疗的 14 名年龄和损伤匹配的患者组成。
14 名冷却患者中有 6 名（42.8%）在最终随访时不完全（50.2[9.7]周）。3 名患者改善为 AIS B，2 名患者改善为 AIS C，1 名患者改善为 AIS D。并发症主要为呼吸和感染性质。然而，在对照组中，观察到类似数量的并发症。在接受低温治疗的患者中，没有出现凝血功能障碍、深静脉血栓形成和肺栓塞等不良事件。
这是第一项关于血管内低温治疗急性颈段 SCI 的安全性和结果的 1 期临床试验。在这一小部分 SCI 患者中，并发症发生率与接受常规体温治疗的患者相似，AIS A 转化率为 42.8%。
