Critical Care of Spinal Cord Injury.

IF 5.4 3区 材料科学 Q2 CHEMISTRY, PHYSICAL
ACS Applied Energy Materials Pub Date : 2024-09-01 Epub Date: 2024-07-15 DOI:10.1007/s11910-024-01357-8
Sabrina L Zeller, Alan Stein, Ilya Frid, Austin B Carpenter, Sauson Soldozy, Cameron Rawanduzy, Jon Rosenberg, Andrew Bauerschmidt, Fawaz Al-Mufti, Stephan A Mayer, Merritt D Kinon, John V Wainwright
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引用次数: 0

Abstract

Purpose of review: Spinal cord injury (SCI) is a major cause of morbidity and mortality, posing a significant financial burden on patients and the healthcare system. While little can be done to reverse the primary mechanical insult, minimizing secondary injury due to ischemia and inflammation and avoiding complications that adversely affect neurologic outcome represent major goals of management. This article reviews important considerations in the acute critical care management of SCI to improve outcomes.

Recent findings: Neuroprotective agents, such as riluzole, may allow for improved neurologic recovery but require further investigation at this time. Various forms of neuromodulation, such as transcranial magnetic stimulation, are currently under investigation. Early decompression and stabilization of SCI is recommended within 24 h of injury when indicated. Spinal cord perfusion may be optimized with a mean arterial pressure goal from a lower limit of 75-80 to an upper limit of 90-95 mmHg for 3-7 days after injury. The use of corticosteroids remains controversial; however, initiation of a 24-h infusion of methylprednisolone 5.4 mg/kg/hour within 8 h of injury has been found to improve motor scores. Attentive pulmonary and urologic care along with early mobilization can reduce in-hospital complications.

脊髓损伤的重症监护。
审查目的:脊髓损伤(SCI)是发病和死亡的主要原因,给患者和医疗保健系统造成了巨大的经济负担。虽然几乎无法逆转原发性机械损伤,但最大限度地减少缺血和炎症引起的继发性损伤以及避免对神经功能预后产生不利影响的并发症是治疗的主要目标。本文回顾了 SCI 急性重症监护管理中的重要注意事项,以改善预后:神经保护剂(如利鲁唑)可改善神经功能的恢复,但目前仍需进一步研究。目前正在研究经颅磁刺激等各种形式的神经调节。有条件的话,建议在损伤后 24 小时内对 SCI 进行早期减压和稳定。损伤后 3-7 天内,可将平均动脉压目标值从下限 75-80 mmHg 提高到上限 90-95 mmHg,以优化脊髓灌注。皮质类固醇的使用仍存在争议,但在受伤后 8 小时内开始输注 5.4 毫克/千克/小时的甲基强的松龙 24 小时输液可改善运动评分。细心的肺部和泌尿科护理以及早期活动可以减少院内并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
ACS Applied Energy Materials
ACS Applied Energy Materials Materials Science-Materials Chemistry
CiteScore
10.30
自引率
6.20%
发文量
1368
期刊介绍: ACS Applied Energy Materials is an interdisciplinary journal publishing original research covering all aspects of materials, engineering, chemistry, physics and biology relevant to energy conversion and storage. The journal is devoted to reports of new and original experimental and theoretical research of an applied nature that integrate knowledge in the areas of materials, engineering, physics, bioscience, and chemistry into important energy applications.
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