| Objective: Acute myelitis is a rare sporadic acute transverse spinal cordlesions, the cause is not clear at present, and there is no specific treatment.High-dose of methylprednisolone treatment is the most often used in acutetransverse myelitis, but the effect is not very satisfactory. The prognosis withhigh morbidity of acute transverse myelitis is poor, which brings seriouspsychological and economic burden to the patients and their families. With thedevelopment of modern medical technology and the improvement of people’squality of life requirements, treatment of acute myelitis has increasinglyattracted attention. This study was a clinical efficacy observation about theeffect of high-dose methylprednisolone combined with intrathecal injection ofdexamethasone in acute transverse myelitis treatment, aimed at finding a morerapid, efficient, safe and economical treatment, to prevent the progressionearly and timely, to improve the treatment efficacy and prognosis of acutemyelitis, and to improve the life quality of patients.Methods: We consecutively collected106patients of acute transversemyelitis from October2005to November2013in Neurology Department ofthe Second Hospital of Hebei Medical University. Analyze all of the clinicaldata, including age, gender, clinical symptoms and signs, imaging, spinal cordlesions and treatment methods, choosing those treatment with high dosemethylprednisolone and combined with intrathecal injection of dexamethasone,dividing them to the case group and the control group, each30cases. All caseswere eligible for the diagnostic criteria proposed by Transverse MyelitisConsortium Working Group in2012,with clinical manifestations of bilaterallimb paralysis, sensory disturbance and rectal bladder dysfunction, andexcluding merger brain, optic nerve or peripheral nerve damage, other than myelitis caused by metabolic, vascular, and other radioactive elements orcompression of the spinal cord, and except those with hypertension, diabetes,infections, who should not be used with glucocorticoids. The case group:Given methylprednisolone500mg or1000mg in0.9%sodium chlorideinjection, slow infusion, halved methylprednisolone every three days, changedto oral prednisone when methylprednisolone reduced to60mg, Slowlyreduction to discontinuation, at the same time given intrathecal injection ofdexamethasone5mg, every3-5days. The control group: Given methylprednis-olone500mg or1000mg in0.9%sodium chloride injection, slow infusion,halved methylprednisolone every three days, changed to oral prednisone whenmethylprednisolone reduced to60mg, Slowly reduction to discontinuation,without given intrathecal injection of dexamethasone treatment. Dynamicmonitoring two groups of patients electrolytes, blood pressure, blood glucoseand given neurotrophic, calcium, protect the gastric mucosa and otherconventional treatment. Observe and analyze the recovery of motor, sensoryand autonomic nerve function, comparing the treatment effect at7days,14days and21days, and the incidence of adverse reactions and complications.Using SPSS17.0statistical software for statistical analysis. Measurement datawere expressed as mean±standard deviation, Significant difference usingthe t test; Count data using Χ2test; Level data using Wilcoxon W test. P <0.05was considered statistically significant.Results:1General Information AnalysisPatients in the case group aged12-63years, mean age36.03±15.96years;Patients in the control group aged13-64years, mean age35.60±16.67years, the age distribution had no significant difference between the twogroups (P>0.05). The case group consisted of7males and23female, male tofemale ratio1:3.29; The control group consisted of9males and21females,male to female ratio1:2.33, gender composition had no significant differencebetween the two groups(P>0.05). In the case group9patients showedquadriplegia,21patients showed paraplegia; In the control group11patients showed quadriplegia,19patients showed paraplegia, paralysis degree had nosignificant difference between the two groups (P>0.05).In the case group15patients given immunoglobulin; In the control group12patients givenimmunoglobulin, the difference had no statistically significant between thetwo groups (P>0.05).2Comparison of treatment effect between the case group with the controlgroup7days: In the case group0cured,3significant effective,18effective,9ineffective, no deaths; In the control group0cured,0significant effective,14effective,16ineffective, no deaths. Analyzed by2-independent samplesWilcoxon W test, The treatment effect of the two groups had statisticallysignificant difference(P<0.05), and the case group was better than the controlgroup.14days: In the case group0cured,10significant effective,16effective,4ineffective, no deaths; In the control group0cured,4significant effective,20effective,6ineffective, no deaths. The treatment effect of the case group wasbetter than the control group, but analyzed by2-independent samplesWilcoxon W test, the difference had no statistically significant between thetwo groups (P>0.05).21days: In the case group6cured,11significant effective,12effective,1ineffective, no deaths; In the control group1cured,10significant effective,16effective,3ineffective, no deaths. Analyzed by2-independent samplesWilcoxon W test, The treatment effect of the two groups had statisticallysignificant difference(P<0.05), and the case group was better than the controlgroup.3Comparison of the incidence about adverse reactions and complicationsbetween the case group with the control groupIn the case group:2Blood glucose elevated,3Rash,1Pressure sores; Inthe control group:4Rash,2Blood glucose elevated,4Lung infection,3Urinary tract infection,1Pressure sores, the incidence of adverse reactionsand complications in the case group was lower than the control group, and the difference between the two groups had statistically significant (P>0.05).Conclusion:1The age distribution, the gender composition, the paralysis degree andthe proportion of given immunoglobulin between the case group and thecontrol group had no statistically significant difference.2The treatment effect at7days,14days and21days in the case groupwere better than the control group, but analyzed by2-independent samplesWilcoxon W test, the difference at7days and21days in the case group hadstatistically significant, the difference at14days in the case group had nostatistically significant. It maybe related to that the sample size was small, thestudy time was short, and the statistical data had a deviation. It was expectedto repeat demonstrated the study with expanding the sample size. But overall,combined with intrathecal injection of dexamethasone treated better.3The incidence of adverse reactions and complications in the case groupwas lower than the control group, and the difference between the two groupshad statistically significant. |
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