Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Department of Neurosurgery, New York Medical College, Valhalla, NY, USA.
Curr Neurol Neurosci Rep. 2024 Sep;24(9):355-363. doi: 10.1007/s11910-024-01357-8. Epub 2024 Jul 15.
Spinal cord injury (SCI) is a major cause of morbidity and mortality, posing a significant financial burden on patients and the healthcare system. While little can be done to reverse the primary mechanical insult, minimizing secondary injury due to ischemia and inflammation and avoiding complications that adversely affect neurologic outcome represent major goals of management. This article reviews important considerations in the acute critical care management of SCI to improve outcomes.
Neuroprotective agents, such as riluzole, may allow for improved neurologic recovery but require further investigation at this time. Various forms of neuromodulation, such as transcranial magnetic stimulation, are currently under investigation. Early decompression and stabilization of SCI is recommended within 24 h of injury when indicated. Spinal cord perfusion may be optimized with a mean arterial pressure goal from a lower limit of 75-80 to an upper limit of 90-95 mmHg for 3-7 days after injury. The use of corticosteroids remains controversial; however, initiation of a 24-h infusion of methylprednisolone 5.4 mg/kg/hour within 8 h of injury has been found to improve motor scores. Attentive pulmonary and urologic care along with early mobilization can reduce in-hospital complications.
脊髓损伤（SCI）是发病率和死亡率的主要原因，给患者和医疗保健系统带来了巨大的经济负担。虽然对于原发性机械损伤几乎无能为力，但最小化由于缺血和炎症引起的继发性损伤并避免影响神经功能预后的并发症是管理的主要目标。本文综述了 SCI 急性重症监护管理中的重要注意事项，以改善预后。
在现阶段，利鲁唑等神经保护剂可能有助于改善神经恢复，但仍需进一步研究。各种形式的神经调节，如经颅磁刺激，目前正在研究中。当有指征时，建议在损伤后 24 小时内对 SCI 进行早期减压和稳定。脊髓灌注可通过将平均动脉压目标从损伤后 3-7 天的 75-80mmHg 下限优化至 90-95mmHg 上限来实现。皮质类固醇的使用仍存在争议；然而，在损伤后 8 小时内开始 24 小时输注甲基强的松龙 5.4mg/kg/h 已被发现可改善运动评分。注意肺部和泌尿科护理以及早期活动可减少院内并发症。
