急性脊髓损伤患者管理临床实践指南：关于使用琥珀酸甲泼尼龙的建议

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Use of Methylprednisolone Sodium Succinate.

作者信息

Fehlings Michael G, Wilson Jefferson R, Tetreault Lindsay A, Aarabi Bizhan, Anderson Paul, Arnold Paul M, Brodke Darrel S, Burns Anthony S, Chiba Kazuhiro, Dettori Joseph R, Furlan Julio C, Hawryluk Gregory, Holly Langston T, Howley Susan, Jeji Tara, Kalsi-Ryan Sukhvinder, Kotter Mark, Kurpad Shekar, Kwon Brian K, Marino Ralph J, Martin Allan R, Massicotte Eric, Merli Geno, Middleton James W, Nakashima Hiroaki, Nagoshi Narihito, Palmieri Katherine, Skelly Andrea C, Singh Anoushka, Tsai Eve C, Vaccaro Alexander, Yee Albert, Harrop James S

机构信息

Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.

University of Toronto, Toronto, Ontario, Canada.

出版信息

Global Spine J. 2017 Sep;7(3 Suppl):203S-211S. doi: 10.1177/2192568217703085. Epub 2017 Sep 5.

DOI:10.1177/2192568217703085

PMID:29164025

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5686915/

Abstract

INTRODUCTION

The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI).

METHODS

A systematic review of the literature was conducted to address key questions related to the use of MPSS in acute SCI. A multidisciplinary Guideline Development Group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as "we recommend," whereas a weaker recommendation is indicated by "we suggest."

RESULTS

The main conclusions from the systematic review included the following: (1) there were no differences in motor score change at any time point in patients treated with MPSS compared to those not receiving steroids; (2) when MPSS was administered within 8 hours of injury, pooled results at 6- and 12-months indicated modest improvements in mean motor scores in the MPSS group compared with the control group; and (3) there was no statistical difference between treatment groups in the risk of complications. Our recommendations were: (1) "We suggest not offering a 24-hour infusion of high-dose MPSS to adult patients who present after 8 hours with acute SCI"; (2) "We suggest a 24-hour infusion of high-dose MPSS be offered to adult patients within 8 hours of acute SCI as a treatment option"; and (3) "We suggest not offering a 48-hour infusion of high-dose MPSS to adult patients with acute SCI."

CONCLUSIONS

These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in SCI patients.

摘要

引言

本指南的目的是概述甲泼尼龙琥珀酸钠（MPSS）在急性脊髓损伤（SCI）患者中的合理应用。

方法

对文献进行系统回顾，以解决与MPSS在急性SCI中的应用相关的关键问题。一个多学科指南制定小组利用这些信息，并结合他们的临床专业知识，制定了MPSS使用的建议。基于GRADE（推荐分级、评估、制定和评价），强烈推荐表述为“我们建议”，而较弱的推荐则用“我们建议”表示。

结果

系统回顾的主要结论如下：（1）与未接受类固醇治疗的患者相比，接受MPSS治疗的患者在任何时间点的运动评分变化均无差异；（2）在损伤后8小时内给予MPSS时，6个月和12个月时的汇总结果表明，MPSS组的平均运动评分与对照组相比有适度改善；（3）治疗组之间并发症风险无统计学差异。我们的建议是：（1）“我们建议不要对伤后8小时就诊的急性SCI成年患者给予24小时高剂量MPSS输注”；（2）“我们建议在急性SCI 8小时内对成年患者给予24小时高剂量MPSS输注作为一种治疗选择”；（3）“我们建议不要对急性SCI成年患者给予48小时高剂量MPSS输注”。