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Rehabilitation Practice and Science

Translated Title

急性脊髓損傷之藥物治療

Abstract

Acute traumatic spinal cord injury (SCI), a devastating event, results in huge costs to patients and society. Current management emphasizes general supportive care and stabilization of associated spinal columnar injury to prevent worsening of the cord lesions. Most of the numerous experimental studies to investigate pathophysiological changes following acute SCI suggest a two-step mechanism of damage to the spinal cord in which the primary (direct) or mechanical injury caused by trauma initiates secondary (indirect) or progressive autodestructive injury of the cord. During recent years, free oxygen radical generation and lipid peroxidation have been implicated in the secondary injury.Several pharmacological agents have been examined in a variety of animal models. Although methylprednisolone (MP) is the major agent currently being studied, other agents are also being developed. Animal models of SCI treated with steroids in the early 1970s served as the basis for the National Acute Spinal Cord Injury Study (NASCIS) in America. The leading theory is that steroids inhibit post-SCI lipid peroxidation and enhance recovery by inhibiting the injury-induced degenerative cascade that follows. In initial trails, MP was not effective in improving the outcome. In NASCIS II, MP was given in a dosage of 30 mg/kg body weight within 8 hours of injury, followed by the administration of MP, 5.4 mg/kg/hr, for 23 hours. This regimen produced a significant neurologic improvement in one-year follow-up when compared with placebo. The study of NASCIS III trial is intended to determine the best time for starting the MP regimen, the optimal duration of therapy, and the benefits, if any, of substituting tirilazad mesylate for MP after the initial dose. In conclusion, if the initial bolus is started within 3 hours of injury, 24-hour MP treatment is appropriate; if the bolus is not administered until 3-8 hours, treatment should be extended for 48 hours. Recently the administration of high-dose MP has become the standard care in the optimal management of SCI. The therapy should not be given more than 8 hours after injury.

Language

Traditional Chinese

First Page

157

Last Page

182

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