主页 > 医学新闻 >
【drug-news】椎动脉内甲泼尼龙注射的危险——动
Gbolahan O. Okubadejo, Michael R. Talcott, Robert E. Schmidt, Aseem Sharma, Alpesh A. Patel, R. Brian Mackey, Anthony H. Guarino, Christopher J. Moran, and K. Daniel Riew
Background: Intravascular injection of particulate steroids during cervical nerve root blocks has been postulated to be a source of catastrophic neurologic complications that might be avoided with the use of non-particulate steroids. The objective of this study was to compare the effects of direct intravascular injection of particulate and non-particulate steroids on the spinal cord and central nervous system.
Methods: Eleven adult pigs underwent direct injection, under fluoroscopic guidance, into the vertebral artery while under general anesthesia. A particulate steroid (methylprednisolone) was injected into four animals (Group 1), whereas seven animals received a non-particulate steroid (dexamethasone in four animals [Group 2] and prednisolone in three [Group 3]). Following injection, the animals were assessed by direct observation of physical activity and with magnetic resonance imaging. After the animals were killed, brain and spinal cord material was retrieved, fixed in paraformaldehyde for one week, and then subjected to histopathologic analysis.
Results: All four animals in Group 1 failed to regain consciousness after the injection and required ventilatory support. The animals in Groups 2 and 3 recovered fully and demonstrated no evidence of neurologic injury. Magnetic resonance imaging revealed upper cervical cord and brain stem edema in Group 1, but not in Groups 2 and 3. Histologic analysis showed early evidence of hypoxic and ischemic damage—specifically, early eosinophilic neuronal necrosis, nuclear condensation, white-matter pallor, and extracellular edema—in Group 1 but not in Groups 2 and 3.
Conclusions: These data suggest that one etiology of neurologic complications following cervical nerve blocks may be inadvertent intravascular injection of particulate steroids, as all animals injected with methylprednisolone had neurologic deficits while none of the controls injected with non-particulate steroids were affected. To our knowledge, this study is the first to demonstrate that particulate steroids cause neurologic deficits and to suggest that use of non-particulate steroids might prevent such complications.
本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 Perils of Intravascular Methylprednisolone Injection into the Vertebral Artery——An Animal Study
椎动脉内甲泼尼龙注射的危险——动物实验
Background: Intravascular injection of particulate steroids during cervical nerve root blocks has been postulated to be a source of catastrophic neurologic complications that might be avoided with the use of non-particulate steroids. The objective of this study was to compare the effects of direct intravascular injection of particulate and non-particulate steroids on the spinal cord and central nervous system.
背景：颈神经根阻滞中血管内注射颗粒甾体类药物已被公认为严重神经系统并发症的原因，但可通过使用非颗粒甾体避免。本研究旨在比较在脊髓和中枢神经系统中直接血管内注射颗粒型和非颗粒型甾体类药物的效果。
Methods: Eleven adult pigs underwent direct injection, under fluoroscopic guidance, into the vertebral artery while under general anesthesia. A particulate steroid (methylprednisolone) was injected into four animals (Group 1), whereas seven animals received a non-particulate steroid (dexamethasone in four animals [Group 2] and prednisolone in three [Group 3]). Following injection, the animals were assessed by direct observation of physical activity and with magnetic resonance imaging. After the animals were killed, brain and spinal cord material was retrieved, fixed in paraformaldehyde for one week, and then subjected to histopathologic analysis.
方法：使用11只成年猪进行实验，全麻后在透视引导下直接注射椎动脉。4只动物注射颗粒甾体（甲泼尼龙）作为1组，7只动物注射非颗粒甾体（4例注射地塞米松为2组，3例注射泼尼松龙为3组）。注射后直接观察动物的活动行为并行核磁共振成像。处死后取大脑和脊髓组织，多聚甲醛固定1周，行组织病理学检测。
Results: All four animals in Group 1 failed to regain consciousness after the injection and required ventilatory support. The animals in Groups 2 and 3 recovered fully and demonstrated no evidence of neurologic injury. Magnetic resonance imaging revealed upper cervical cord and brain stem edema in Group 1, but not in Groups 2 and 3. Histologic analysis showed early evidence of hypoxic and ischemic damage—specifically, early eosinophilic neuronal necrosis, nuclear condensation, white-matter pallor, and extracellular edema—in Group 1 but not in Groups 2 and 3.
结果：1组的全部4只动物注射后无法复苏并需辅助通气支持。2组和3组动物恢复良好且无神经系统损伤表现。核磁共振检查显示1组动物上颈髓和脑干水肿，2组和3组动物未见。组织学检查显示1组动物出现早期低氧和缺血性损伤表现，尤其是嗜酸性神经元坏死、核凝缩、白质苍白以及胞外水肿，而2组和3组动物未见。
阅读本文的人还阅读：
作者:admin@医学,生命科学 2010-11-23 17:11
医学,生命科学网