St. John's Mercy Medical Center, St. Louis University, 621 S. New Ballas Rd, suite 4006B, St. Louis, MO 63141, USA.
Neurocrit Care. 2010 Dec;13(3):389-92. doi: 10.1007/s12028-010-9454-y.
Spinal cord injury (SCI) is a devastating disease process that can occur as a consequence of motor vehicle collisions, falls, or other traumatic injuries. Persistent bradycardia was found to be universally present in all high cervical SCI patients. Limited data exists to suggest the most effective therapy for the bradycardia associated with high cervical SCI. Treatment includes atropine, epinephrine, dopamine, and even implantable cardiac pacemakers, all of which have their risks and side effects. There are no prospective studies to evaluate methylxanthines for the treatment of bradycardia secondary to cervical SCI.
We report on four patients in whom Theophylline was successfully used enterally as a second line agent to treat bradycardia secondary to cervical SCI. We also reported on two patients in whom Theophylline was successfully used as a first line agent. Bradycardia resolved in all patients
Theophylline levels were below toxic levels in all of the patients and no side effects from theophylline were observed.
Theophylline's use via enteral route can successfully and safely treat SCI-related bradycardia, and may help avoid the long term use of inotropic and chronotropic infusions and pacemakers and their associated risks and complications. We strongly recommend further studies to establish the role of this agent as a first line therapy in this specific patient population. Optimal dosing and duration of therapy will also need to be established.
脊髓损伤（SCI）是一种破坏性疾病，可由机动车碰撞、跌倒或其他创伤性损伤引起。研究发现，所有高位颈椎 SCI 患者均普遍存在持续性心动过缓。目前仅有有限的数据表明，对于高位颈椎 SCI 相关的心动过缓，哪种治疗方法最有效。治疗方法包括阿托品、肾上腺素、多巴胺，甚至植入式心脏起搏器，但这些方法都有各自的风险和副作用。目前尚无前瞻性研究评估茶碱类药物治疗颈椎 SCI 引起的心动过缓。
我们报告了 4 例患者，他们成功地使用茶碱作为二线药物经肠内给药治疗因高位颈椎 SCI 引起的心动过缓。我们还报告了 2 例患者，他们成功地使用茶碱作为一线药物治疗。所有患者的心动过缓均得到缓解。
所有患者的茶碱水平均低于中毒水平，未观察到茶碱的副作用。
茶碱经肠内途径给药可成功且安全地治疗 SCI 相关心动过缓，并可能有助于避免长期使用正性肌力和变时性输注以及起搏器及其相关风险和并发症。我们强烈建议进一步研究，以确定该药物在这一特定患者群体中的一线治疗作用。还需要确定最佳剂量和治疗持续时间。
