Kwon Woo-Keun, Ham Chang-Hwa, Byun Joonho, Jeong Je Hoon, Ko Myeong Jin, Lee Subum, Lee Byung-Jou, Kim Jong Hyun
Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
Korean J Neurotrauma. 2024 Dec 26;20(4):225-233. doi: 10.13004/kjnt.2024.20.e44. eCollection 2024 Dec.
Spinal cord injury (SCI) following high-energy trauma often leads to lasting neurologic deficits and severe socioeconomic impact. Effective neurointensive care, particularly in the early stages post-injury, is essential for optimizing outcomes. This review discusses the role of neurointensive care in managing SCI, emphasizing early assessment, stabilization, and intervention strategies based on recent evidence-based practices. SCI results from primary mechanical damage to the spinal cord, triggering secondary injuries involving vascular and cellular dysfunction. Early neurointensive care focuses on stabilizing airway, breathing, and circulation while preventing further spinal damage. Imaging and neurologic assessments, including the ASIA scale, guide the management plan. Early decompressive surgery within 24 hours is widely supported for patients with spinal instability or cord compression. Pharmacologic strategies aim to reduce secondary injury, though standardization remains limited. Prophylaxis for deep vein thrombosis and pulmonary embolism, intensive pulmonary support, and monitoring for pressure sores are critical in early-phase SCI. Early neurointensive care and surgical interventions play a pivotal role in mitigating SCI progression. Optimal care requires a multifaceted approach addressing both neurologic and systemic complications, significantly influencing recovery and long-term quality of life. Further research is needed to standardize pharmacologic treatments and optimize surgical timing.
高能创伤后发生的脊髓损伤（SCI）常导致持久的神经功能缺损和严重的社会经济影响。有效的神经重症监护，尤其是在损伤后的早期阶段，对于优化治疗结果至关重要。本综述讨论了神经重症监护在管理脊髓损伤中的作用，强调基于近期循证实践的早期评估、稳定和干预策略。脊髓损伤源于脊髓的原发性机械损伤，引发涉及血管和细胞功能障碍的继发性损伤。早期神经重症监护的重点是稳定气道、呼吸和循环，同时防止脊髓进一步损伤。包括美国脊髓损伤协会（ASIA）量表在内的影像学和神经学评估指导治疗计划。对于存在脊柱不稳定或脊髓受压的患者，广泛支持在24小时内进行早期减压手术。药物治疗策略旨在减少继发性损伤，不过标准化程度仍然有限。深静脉血栓形成和肺栓塞的预防、强化肺部支持以及压疮监测在脊髓损伤早期至关重要。早期神经重症监护和手术干预在减轻脊髓损伤进展方面起着关键作用。最佳治疗需要采取多方面方法来解决神经和全身并发症，这对恢复和长期生活质量有重大影响。需要进一步研究来规范药物治疗并优化手术时机。
