TERAPIJA METILPREDNIZOLONOM U AKUTNIM POVREDAMA KIČMENE MOŽDINE
Sažetak
Povrede kičmene moždine predstavljaju i danas veoma veliki izazov kada je u pitanju lečenje. Ovo stanje je veoma često povezano sa dugotrajnim lečenjem i sa velikom učestalošću ranih i kasnih komplikacija. Cilj lečenja jeste da se u što kraćem vremenskom periodu obezbedi oslobađanje kičmene moždine od pritiska
izazvanog hematomom ili koštanim fragmentima. Zato je hirurška dekompresija kičmene moždine uvek prvi izbor lečenja, ukoliko postoji indikacija za ovu vrstu intervencije. Osim invazivnih metoda, lečenje podrazumeva i upotrebu različitih medikamenata sa ciljem smanjenja edema i inflamacije, naročito u prvim
danima nakon povrede. Jedan od najčešće upotrebljavanih lekova u ovu svrhu je metilprednizolon, ali je njegova upotreba i dalje kontroverzna, pogotovo kad su u pitanju vreme davanja i određivanje doze. Ovaj lek se već decenijama upotrebljava u lečenju povreda kičmene moždine, međutim tokom vremena su se
smenjivali različiti protokoli. Cilj ovog članka je da prikaže savremene stavove kad je u pitanju upotreba kortikosteroida kod akutnih povreda kičmenog stuba. Dat je prikaz najznačajnijih protokola za primenu metilprednizolona koji su danas u upotrebi (National Acute Spinal Cord Injury Studies - NASCIS I, II, i III) uz kratak pregled literature na ovu temu. Analizom dostupnih podataka pokazano je da je upotreba metilprednizolona kod povreda kičmene moždine i dalje kontroverzna zbog neizvesnog odnosa terapijske koristi i mogućih nuspojava. Savremeni stav je da je primena leka opravdana u prvih osam časova nakon povrede, pogotovo ukoliko se radi o inkompletnom neurološkom deficitu, tačnije u slučajevima kvadripareze
ili parapareze.
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