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A Series of Systematic Reviews on the Treatment of Acute Spinal Cord Injury: A Foundation for Best Medical Practice

机译:一系列急性脊髓损伤的系统评价:最佳医学实践的基础

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摘要

The treatment of acute spinal cord injury (SCI) is a multidisciplinary effort that spans from the time of injury through to an acute care center, and in some cases the remainder of the individual's life. Recovery from SCI depends on the care received at each point along this spectrum in time. In order to facilitate the practice of evidence-based medicine and best clinical practices, a multidisciplinary team of clinicians and researchers systematically reviewed the literature on SCI and set out to answer pertinent clinical questions and establish evidence-based recommendations. This article introduces the series of systematic reviews, summarizes the most notable findings, and gives an overview of the questions asked in each review and the evidence-based recommendations for care. Some of the most important recommendations are as follows: (1) Patients should be immobilized before transport to a hospital using a cervical collar, head immobilization, and a spinal board; (2) MRI is strongly recommended for the prognostication of acute SCI; (3) early surgical intervention (from 8–24 h) should be considered following acute traumatic SCI; (4) SCI patients are at significant risk of cardiovascular and respiratory problems and management should proactively anticipate these potential complications; and (5) outcomes can be improved by management in specialized centers with access to intensive care.
机译:急性脊髓损伤(SCI)的治疗是多学科的工作,其范围从受伤时间到急救中心,有时还包括个人的余生。从SCI的恢复取决于该时间范围内每个点的护理情况。为了促进循证医学的实践和最佳临床实践,由多学科的临床医生和研究人员组成的团队系统地审查了SCI的文献,并着手回答相关的临床问题并建立基于证据的建议。本文介绍了一系列的系统评价,总结了最显着的发现,并概述了每个评价中提出的问题以及基于证据的护理建议。一些最重要的建议如下:(1)在运送到医院之前,应使用颈托,头部固定装置和脊椎固定板将患者固定下来; (2)强烈建议将MRI用于急性SCI的预后; (3)急性外伤性脊髓损伤后应考虑早期手术干预(8-24h); (4)SCI患者有严重的心血管和呼吸系统疾病风险,管理人员应积极预测这些潜在的并发症; (5)可以通过获得重症监护的专门中心的管理来改善结果。

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