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2013 CNS/AANS 急性颈椎和脊髓损伤管理指南

2013-07-02 MedSci MedSci原创

急性颈椎损伤脊髓损伤
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近期，由美国神经外科医师大会（CNS）和美国神经外科医师协会（AANS）发布的关于急性颈椎及脊髓损伤的最新循证医学指南首次明确指出，急性脊髓损伤后早期不推荐使用类固醇，这项新推荐是112项循证学推荐之一。 神经外科医师协会会长威斯康辛大学麦迪逊分校医学和公共卫生学院神经外科教授Daniel K. Resnick说，之前有关类固醇激素使用的推荐称，只要医生认识到使用这些药物导致损害的几率高于其使用

近期，由美国神经外科医师大会（CNS）和美国神经外科医师协会（AANS）发布的关于急性颈椎及脊髓损伤的最新循证医学指南首次明确指出，急性脊髓损伤后早期不推荐使用类固醇，这项新推荐是112项循证学推荐之一。

神经外科医师协会会长威斯康辛大学麦迪逊分校医学和公共卫生学院神经外科教授Daniel K. Resnick说，之前有关类固醇激素使用的推荐称，只要医生认识到使用这些药物导致损害的几率高于其使用获益就可以使用。Resnick博士说，“在我看来，我们现在要返回到原始数据，从根本上纠正某些在过去不正确的一些做法。”

这些推荐，包括最新的研究以及以往的研究，均发表于《神经外科学》杂志的3月份增刊上。

该指南是2002年出版的仅有76项推荐的原始指南的更新版。新版指南有19项I级推荐，每项均有I类证据支持。还有16项基于II类证据的II级推荐和77项基于III类证据的III级推荐。

但由于缺乏相关证据，新指南未包括脊髓损伤（SCI）患者使用低温治疗或其他治疗此类损伤方面的资料。

与旧版指南不同，在“急性脊髓损伤的药物治疗”一章中的推荐是，急性脊髓损伤的第24至48小时内，不能使用甲基强的松龙（MP）治疗。该标准进行这样修订是因为临床上缺乏支持这些药物有益的医学证据。事实上，该报告还包括表明高剂量类固醇带来有害的不利影响的确凿证据。

研究表明，该人群中使用类固醇会导致较高的感染率，较高的败血症发生率，滞留在重症监护病房时间较长，并导致并发症增多，有时甚至引起死亡。

这项新建议似乎为神经外科医师提供了明确的方向。美国加州大学洛杉矶医学中心的Langston Holly博士说，这将为患者护理提供一种直接的和有益的影响。他说，“2012版指南明确规定，急性脊髓损伤中不建议使用甲强龙，

没有I级或II级证据支持甲强龙的使用。与之形成鲜明对比的是，有I级到III级证据表明这种治疗方法具有有害的副作用。”

1.Foreword.pdf

2.Commentary.pdf

3.Joint Section on Disorders of the Spine and.pdf

4.Introduction_to_the_Guidelines_for_the_Management.pdf

5.Methodology_of_the_Guidelines_for_the_Management.pdf

7.Transportation_of_Patients_With_Acute_Traumatic.pdf

8.Clinical_Assessment_Following_Acute_Cervical.pdf

9.Radiographic_Assessment.pdf

10.Initial_Closed_Reduction_of_Cervical_Spinal.pdf

11.The_Acute_Cardiopulmonary_Management_of_Patients.pdf

12.Pharmacological_Therapy_for_Acute_Spinal_Cord.pdf

13.Occipital_Condyle_Fractures.pdf

14.The_Diagnosis_and_Management_of_Traumatic.pdf

15.Management_of_Isolated_Fractures_of_the_Atlas_in.pdf

16.Management_of_Isolated_Fractures_of_the_Axis_in.pdf

17.Management_of_Acute_Combination_Fractures_of_the.pdf

18.Os_Odontoideum.pdf

19.Subaxial_Cervical_Spine_Injury_Classification.pdf

20.Treatment_of_Subaxial_Cervical_Spinal_Injuries.pdf

21.Management_of_Acute_Traumatic_Central_Cord.pdf

22.Management_of_Pediatric_Cervical_Spine_and_Spinal.pdf

23.Spinal_Cord_Injury_Without_Radiographic.pdf

24.Management_of_Vertebral_Artery_Injuries_Following.pdf

25.Deep_Venous_Thrombosis_and_Thromboembolism_in .pdf

26.Nutritional_Support_After_Spinal_Cord_Injury.pdf

 

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    2014-01-24 ms3830150583600765

    #管理指南#

    0

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    2013-09-01 zhyy88

    #CNS/AANS#

    0

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    2013-07-07 lg.zhao

    #CNS#

    0

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    2013-07-04 智者为医08

    #损伤#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1936255, encodeId=70d01936255c2, content=<a href='/topic/show?id=daa1e60387b' target=_blank style='color:#2F92EE;'>#管理指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76038, encryptionId=daa1e60387b, topicName=管理指南)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIUEDhSibBFt8TicgFCCSBtW10SxVJicDpibTCucns8L1YaiaKpibWOkv8hYpJ0LeTVUH1Ab4sfica9bxiccA/132, createdBy=dd282500126, createdName=ms3830150583600765, createdTime=Fri Jan 24 21:55:00 CST 2014, time=2014-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1783271, encodeId=a6271e8327140, content=<a href='/topic/show?id=bec5493e77' target=_blank style='color:#2F92EE;'>#CNS/AANS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4937, encryptionId=bec5493e77, topicName=CNS/AANS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=40be178, createdName=zhyy88, createdTime=Sun Sep 01 22:55:00 CST 2013, time=2013-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1914216, encodeId=587519142168c, content=<a href='/topic/show?id=4b8349356f' target=_blank style='color:#2F92EE;'>#CNS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4935, encryptionId=4b8349356f, topicName=CNS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c737344, createdName=lg.zhao, createdTime=Sun Jul 07 20:55:00 CST 2013, time=2013-07-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1396768, encodeId=ca7b1396e687b, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Thu Jul 04 00:55:00 CST 2013, time=2013-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1446413, encodeId=ec76144641373, content=<a href='/topic/show?id=2e3016e437' target=_blank style='color:#2F92EE;'>#AAN#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1674, encryptionId=2e3016e437, topicName=AAN)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIt6X4iaHW8bDticcBSHUibNWk4Koe2icf0pdIOicSueicR3AKmviaSNPHkf9bCEicRK0anXEu3DjolU2EmkQ/132, createdBy=98ca5217513, createdName=bluefate123, createdTime=Thu Jul 04 00:55:00 CST 2013, time=2013-07-04, status=1, ipAttribution=)]
    2013-07-04 bluefate123

    #AAN#

    0

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