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中国临床药理学与治疗学 ›› 2017, Vol. 22 ›› Issue (8): 937-942.

• 药物治疗学 • 上一篇    下一篇

盐酸氨溴索联合大剂量甲基强的松龙冲击治疗促进胸腰椎骨折合并脊髓损伤术后神经功能恢复作用的初步探讨

张 朋1,陈勇忠2,王金星1,张金锋1,翁超群1,叶忠兴1   

  1. 1福建三博福能脑科医院神经外科,福州 350001,福建; 2南京军区福州总院四七六医院骨科,福州 350002,福建
  • 收稿日期:2017-03-31 修回日期:2017-05-10 出版日期:2017-08-26 发布日期:2017-08-18
  • 通讯作者: 王金星,男,硕士研究生,副主任医师,研究方向:脊柱脊髓相关疾病及小儿脑瘫的诊治。 Tel:13705979508 E-mail:wjxing1005@126.com
  • 作者简介:张朋,男,硕士研究生,主治医师,研究方向:脊柱脊髓及疼痛相关疾病的诊断和治疗。 Tel:15980151980E-mail:dr.zpeng@hotmail.com
  • 基金资助:

    福建省自然科学基金(2015J01494)

Effect of ambroxol hydrochloride combined with high-dose methylprednisolone therapy on the recovery of neurological function after spinal cord injury in patients with thoracolumbar fractures

ZHANG Peng 1, CHEN Yongzhong 2, WANG Jinxing1 , ZHANG Jinfeng 1, WENG Chaoqun 1, YE Zhongxing 1   

  1. 1 Department of Neurosurgery, Fujian Sanbo Funeng Brain Hospital, Fuzhou 350001, Fujian, China; 2 Department of Orthopedics, the 476th Hospital of Fuzhou General Hospital of Nanjing Military Region, Fuzhou 350002, Fujian, China
  • Received:2017-03-31 Revised:2017-05-10 Online:2017-08-26 Published:2017-08-18

摘要:

目的: 初步探讨盐酸氨溴索联合大剂量甲基强的松龙(methylprednisolone,MP)冲击治疗对胸腰椎骨折合并急性脊髓损伤术后神经功能恢复的作用。方法: 选取2015年2月至2016年8月在南京军区福州总院四七六医院骨科就诊并急诊手术治疗的胸腰椎骨折患者合并脊髓损伤患者48例作为研究对象。按随机数字表法分为联合治疗组和对照组,每组24例。2组均根据脊髓受压程度急诊实施椎管减压及植骨融合内固定手术,在15 min内经静脉快速滴注总量为30 mg/kg的MP(冲击治疗),45 min后继续给予5.4 mg·kg-1·h-1的MP,持续时间为23 h。联合治疗组:在对照组基础上,给予静脉滴注盐酸氨溴索(60 mg/次,q12h),持续治疗30 d。2组患者均给予抗感染、止血、脱水及对症治疗,并静脉滴注奥美拉唑(30 mg/次,q12h,持续3 d)预防消化道应激性溃疡发生。随访6个月,依据Frankel分级法判定2组治疗后临床疗效,评估比较2组患者治疗前、治疗后1个月、6个月各时间点的ASIA感觉、运动评分;并记录2组的药物不良反应发生情况。结果: 2组患者基线资料如年龄、性别比、体质量指数等比较,差异无统计学意义(P>0.05);经治疗后第6个月联合治疗组总有效率显著高于对照组(87.5% vs. 62.5%,P<0.05);2组患者在治疗第1个月、6个月ASIA感觉、运动评分均较治疗前明显升高(P<0.05),与对照组相比,联合治疗组感觉、运动评分在治疗后第1个月、6个月显著升高(P<0.05);在不良反应发生情况方面,联合治疗组和对照组比较差异无统计学意义(29.2% vs. 33.3%,P>0.05)。结论: 盐酸氨溴索联合大剂量MP冲击治疗可显著改善胸腰椎骨折合并急性脊髓损伤患者的神经损伤程度,促进神经功能恢复,较单一MP冲击治疗效果更佳,但仍需更多临床和实验室研究进一步证实。

关键词: 盐酸氨溴索, 甲基强的松龙, 胸腰椎骨折合并脊髓损伤, 神经功能

Abstract:

AIM: To discuss the therapeutic effect of ambroxol hydrochloride combined with high-dose methylprednisolone (MP) on the recovery of neurological function after spinal cord injury in patients with thoracolumbar fractures.  METHODS: Forty eight patients with thoracolumbar fractures plus spinal cord injury admitted to our hospital from Feburary 2016 to August 2016 were randomly divided into the combination group and the control group according to random number table (n=24). All the patients were performed decompression and internal fixation operation, and MP was given 30 mg/kg intravenously for 15 min, another 5.4 mg·kg-1·h-1 MP was given intravenously for 23 h 45 minutes later. Based on the treatment of the control group, the combination group received extra ambroxol hydrochloride intravenously (60 mg/time, 1 time/12 h), continued for 30 days. Patients in both groups were given anti-infection, hemostatic, dehydration, and symptomatic treatment, and intravenous drip of omeprazole (30 mg/time, 1 time/12 h, 3 d) was administered to prevent gastrointestinal stress ulcer. All patients were followed up for 6 months; the clinical curative effect in two groups were determined according to Frankel classification method; ASIA sensory and motor score were evaluated and compared between two groups before and 1 month and 6 month after treatment; adverse drug reactions were recorded. RESULTS:No statistically significant difference were observed with the baseline data such as age,sex,heart rate,breathing and body mass index between the two groups(P>0.05).After 6 months' treatment,the total effective rate in the combination group was significantly higher than that of the control group (87.5% vs. 62.5%, P<0.05); ASIA sensory and motor score were significantly elevated compared with before treatment in both groups 1 month and 6 month after treatment (P<0.05), and between the two groups, the combination group presented more significant improvement (P<0.05); No statistically significant difference was observed with adverse reaction occurrence between the two groups (29.2% vs. 33.3%, P>0.05).CONCLUSION:Compared with simple MP shock treatment, ambroxol hydrochloride combined with high-dose MP can significantly alleviate the injured neurological function and improve neural functional recovery in patients with thoracolumbar fractures combined with spinal cord injury, whereas more clinical and laboratory research are needed to confirm the effect.

Key words: ambroxol hydrochloride, methylprednisolone, thoracolumbar fractures combined with spinal cord injury, neurological function

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