本文選題：急性脊髓炎　切入點：鞘內(nèi)注射　出處：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：急性脊髓炎(Acute Myelitis)是一種少見的散發(fā)性脊髓急性橫貫性病變，目前病因尚不明確，無特效治療。臨床上大多采用大劑量甲基潑尼松龍沖擊治療，但效果不是很令人滿意。該病預(yù)后差，致殘率高，給患者及其家庭帶來了嚴重的心理和經(jīng)濟負擔(dān)。隨著現(xiàn)代醫(yī)學(xué)技術(shù)的發(fā)展和人們對生活質(zhì)量要求的提高，急性脊髓炎的治療效果已日趨引起人們的重視。本研究通過對大劑量甲基潑尼松龍沖擊及聯(lián)合鞘內(nèi)注射地塞米松治療急性脊髓炎的臨床療效的觀察，旨在找到一種更加有效、經(jīng)濟且安全性高，能早期阻止病情進展并促進神經(jīng)功能恢復(fù)的治療方法，以減少急性脊髓炎患者的后遺癥，降低致殘率，改善預(yù)后，提高患者的生活質(zhì)量。 方法：本論文連續(xù)搜集了2005年10月至2013年11月在河北醫(yī)科大學(xué)第二醫(yī)院神經(jīng)內(nèi)科住院的106例急性脊髓炎患者。分析所有急性脊髓炎患者的病例資料，包括年齡、性別、臨床癥狀和體征、影像學(xué)檢查、脊髓病變情況、治療方法等，選擇其中給予大劑量甲基潑尼松龍沖擊治療及聯(lián)合鞘內(nèi)注射地塞米松治療的患者各30例，分為對照組和治療組。所有入選病例均符合急性脊髓炎國際協(xié)作組2012年制定的急性脊髓炎診斷標(biāo)準(zhǔn)，臨床表現(xiàn)為病變平面以下雙側(cè)肢體癱瘓、傳導(dǎo)束型感覺障礙和直腸膀胱功能障礙，并除外合并腦組織、視神經(jīng)或周圍神經(jīng)損害的患者，除外由代謝性、血管性、壓迫性或者放射性等因素導(dǎo)致的脊髓炎患者，除外合并有高血壓、糖尿病、感染等不宜使用激素的患者。治療組：給予甲基潑尼松龍500mg或1000mg加入0.9%氯化鈉注射液中，緩慢靜點，每三天甲基潑尼松龍量減半，減至60mg時改為口服醋酸潑尼松片，緩慢減量至停藥，同時行腰椎穿刺術(shù)給予鞘內(nèi)注射地塞米松5mg，每3-5天一次，每次5mg。對照組：給予甲基潑尼松龍500mg或1000mg加入0.9%氯化鈉注射液中，緩慢靜點，每三天減半，減至60mg時改為口服醋酸潑尼松片，緩慢減量至停藥，未給予鞘內(nèi)注射地塞米松治療。動態(tài)監(jiān)測兩組患者的電解質(zhì)、血壓、血糖等，并給予營養(yǎng)神經(jīng)、補鈣、保護胃黏膜等常規(guī)治療。觀察分析患者的肌力、感覺、自主神經(jīng)功能恢復(fù)情況，比較兩組患者7d、14d、21d的治療效果及不良反應(yīng)和并發(fā)癥的發(fā)生率是否有差別。使用SPSS17.0統(tǒng)計軟件對數(shù)據(jù)進行統(tǒng)計學(xué)分析處理。計量資料以均數(shù)±標(biāo)準(zhǔn)差(x±S)表示，統(tǒng)計學(xué)差異分析選用t檢驗；計數(shù)資料選用Χ2檢驗；等級資料選用Wilcoxon秩和檢驗。P0.05為差異有統(tǒng)計學(xué)意義。 結(jié)果： 1一般資料 治療組患者年齡12-63歲，平均年齡36.03±15.96歲；對照組患者年齡13-64歲，平均年齡35.60±16.67歲，兩組之間年齡分布無明顯差異（P0.05）。治療組男性7例，女性23例，男女比例1:3.29；對照組男性9例，女性21例，男女比例1:2.33，兩組之間性別構(gòu)成無明顯差異（P0.05）。治療組9例患者表現(xiàn)為四肢癱，21例患者表現(xiàn)為截癱；對照組11例患者表現(xiàn)為四肢癱，19例患者表現(xiàn)為截癱，兩組之間癱瘓程度無明顯差異（P0.05）。治療組中15例患者給予丙種球蛋白治療，對照組中12例患者給予丙種球蛋白治療，其差異無統(tǒng)計學(xué)意義（P0.05）。 2治療組和對照組在7d、14d、21d治療效果的比較 7d：治療組治愈0例，顯效3例，有效18例，無效9例，無死亡病例；對照組治愈0例，顯效0例，有效14例，無效16例，無死亡病例。經(jīng)兩個獨立樣本的秩和檢驗，兩組之間有統(tǒng)計學(xué)差異（P0.05），治療組的治療效果優(yōu)于對照組。 14d：治療組治愈0例，顯效10例，有效16例，無效4例，無死亡病例；對照組治愈0例，顯效4例，，有效20例，無效6例，無死亡病例。治療組的治療效果優(yōu)于對照組，經(jīng)兩個獨立樣本的秩和檢驗，兩組之間無統(tǒng)計學(xué)差異（P0.05）。 21d：治療組治愈6例，顯效11例，有效12例，無效1例，無死亡病例；對照組治愈1例，顯效10例，有效16例，無效3例，無死亡病例。經(jīng)兩個獨立樣本的秩和檢驗，兩組之間有統(tǒng)計學(xué)差異（P0.05），治療組的治療效果優(yōu)于對照組。 3不良反應(yīng)和并發(fā)癥發(fā)生率的比較 治療組患者出現(xiàn)血糖升高2例，皮疹3例，壓瘡1例；對照組患者出現(xiàn)丘疹4例，血糖升高2例，肺部感染4例，泌尿系感染3例，壓瘡1例。治療組不良反應(yīng)和并發(fā)癥的發(fā)生率（20%）低于對照組（46.7%），其差異有統(tǒng)計學(xué)意義（P0.05）。 結(jié)論： 1治療組和對照組在年齡分布、性別構(gòu)成、癱瘓程度及應(yīng)用丙種球蛋白的比例之間的比較無明顯差異。 2治療組在7d、14d、21d的治療效果均優(yōu)于對照組，但經(jīng)兩個獨立樣本的秩和檢驗分析，其中在7d、21d時兩組之間的差異有統(tǒng)計學(xué)意義，而在14d時兩組之間的差異無統(tǒng)計學(xué)意義�？紤]可能與樣本量小，觀察時間短，療效標(biāo)準(zhǔn)受主觀因素干擾，統(tǒng)計數(shù)據(jù)可能存在偏差有關(guān)，有待于擴大樣本量反復(fù)多次進行進一步研究論證。但總體看來，聯(lián)合鞘內(nèi)注射地塞米松治療的效果更好。 3治療組不良反應(yīng)和并發(fā)癥的發(fā)生率低于對照組，其差異有統(tǒng)計學(xué)意義�？紤]可能與聯(lián)合治療使神經(jīng)功能缺損恢復(fù)快，早期療效好，治療時間短，主動運動增多，尿管保留時間縮短等有關(guān)。
[Abstract]:Objective : Acute Myasthenia is a rare and sporadic acute transverse lesion of the spinal cord . The cause of the disease is not clear and has no special effect . The clinical curative effect of this study is not satisfactory . With the development of modern medical technology and the improvement of the quality of life , the treatment effect of acute mycitis has become more and more important .

Methods : A total of 106 patients with acute mycitis admitted to the Second Affiliated Hospital of Hebei Medical University from October 2005 to November 2013 were collected , including age , sex , clinical symptoms and signs , imaging examination , spinal cord pathological condition , treatment method and so on . Statistical difference analysis selects t test ;
The counter data shall be tested by X - ray 2 ;
Wilcoxon rank sum test was used in the grade data , and the difference was statistically significant .

Results :

1 General information

The age of patients in the treatment group was 12 - 63 years , the mean age was 36.03 鹵 15.96 years .
In the control group , the age ranged from 13 to 64 years , the mean age was 35.60 鹵 16.67 years , there was no significant difference between the two groups ( P0.05 ) .
There was no significant difference between the two groups ( P0.05 ) .
In the control group , 11 patients showed limbs paralysis , 19 cases were paraplegic , there was no significant difference between the two groups ( P0.05 ) . 15 patients in the treatment group were treated with gamma globulin , 12 of the control group were treated with gamma globulin , and the difference was not statistically significant ( P0.05 ) .

Comparison of therapeutic effect between treatment group and control group on 7d , 14d and 21d

7d : 0 cases were cured in the treatment group , 3 cases were markedly effective , 18 cases were effective , 9 cases were ineffective and no death cases were reported ;
In the control group , 0 cases were cured , 0 cases were markedly effective , 14 cases were effective , 16 cases were ineffective and no death cases were reported . There was statistical difference between the two groups after two independent samples ( P0.05 ) . The treatment effect of the treatment group was better than that of the control group .

14 days : 0 cases were cured in the treatment group , 10 cases were markedly effective , 16 cases were effective , 4 cases were ineffective and no death cases were reported ;
In the control group , 0 cases were cured , 4 cases were markedly effective , 20 cases were effective , 6 cases were ineffective and no death cases were found . The treatment effect of the treatment group was better than that of the control group . There was no statistical difference between the two groups after the rank sum test of the two independent samples ( P0.05 ) .

21 days : 6 cases were cured in the treatment group , 11 cases were markedly effective , 12 cases were effective , 1 case was ineffective and no death cases were reported ;
In the control group , 1 case was cured , 10 cases were markedly effective , 16 cases were effective , 3 cases were ineffective and no death cases were reported . There was statistical difference between the two groups after two independent samples ( P0.05 ) , and the treatment effect of the treatment group was better than that of the control group .

3 Comparison of the incidence of adverse reactions and complications

In the treatment group , there were 2 cases of elevated blood glucose , 3 cases of rash and 1 case of pressure ulcer ;
In the control group , there were 4 cases of papules , 2 cases of hyperglycemia , 4 cases of pulmonary infection , 3 cases of urinary system infection , 1 case of pressure ulcer . The incidence rate of adverse reactions and complications in the treatment group ( 20 % ) was lower than that in the control group ( 46.7 % ) , and the difference was significant ( P0.05 ) .

Conclusion :

There was no significant difference between treatment group and control group in age distribution , gender composition , degree of paralysis and the proportion of immunoglobulin .

There was no significant difference between the two groups at 7 d , 14 d and 21 d after 7 d , 14 d and 21 d , but there was no significant difference between the two groups at 7 d and 21 d .

3 . The incidence of adverse reactions and complications in the treatment group was lower than that of the control group , and the difference was statistically significant . Considering the possibility of the combination therapy , the nerve function defect could be recovered quickly , the early curative effect is good , the treatment time is short , the active motion is increased , the retention time of the urine tube is shortened , and the like .

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R744.3

【引證文獻】

相關(guān)期刊論文 前2條

1 李蘊;李學(xué)杰;;急性脊髓炎的臨床特征與激素治療的療效分析[J];中國醫(yī)藥指南;2016年35期

2 龐艷;;研究甲基潑尼松龍沖擊治療急性脊髓炎的臨床效果[J];世界最新醫(yī)學(xué)信息文摘;2015年A2期

本文編號：1706223