严重脊髓受压患者围手术期应用甲基强地松龙的临床观察

Clinical application of methylprednisolone in cases with severe spinal cord compression during perioperative period

目的:观察严重脊髓受压患者围手术期应用甲基强的松龙(MP)预防和治疗脊髓神经功能损害的效果。方法:2002年5月～2005年5月,选择严重颈或胸椎管狭窄症患者(压迫超过椎管的1/2)51例,采用一期后路,或二期后、前路椎管减压手术治疗,减压前30min给予MP1000mg冲击(用药组),如患者手术后4～6h以内出现脊髓损伤平面上升或加重的情况,排除血肿压迫等其他原因后,按照NASCISⅡ提出的脊髓损伤8h以内的冲击治疗方案执行;其余患者术后第1天起MP按照200mg、200mg、80mg、80mg逐日减量,共应用4d。同期15例同组手术医师治疗的同类型患者作为对照组(未使用MP作为预防和治疗手段,其余处理相同)。采用JOA评分法对术前、术后7d、术后1个月及术后1年时两组患者的脊髓功能进行评分。结果:两组患者无围手术期死亡病例,全部病例随访0.5～3.5年。术前JOA评分用药组为5.5±2.9分,对照组为5.2±3.3分,无显著性差异(P>0.05)。术后各时间点两组JOA评分差异有显著性(P<0.05)。结论:在严重脊髓受压患者的围手术期,采用MP预防和治疗脊髓神经功能损害效果可靠。

Objective：To investigate the effect of methylprednisolone（MP） on patients with spinal cord injury during perioperative period.Method：From May 2002 to May 2005,51 patients with serious cervical or thoracical spinal stenosis （more than 1/2 spinal cannal were engrossed） were performed with anterior or posterior canal decompression in one stage or combined posterior and anterior approach in two stages.All cases were administrated with 1000mg MP in less than 30min before decompression with dose decreased day by day.In patients with neurological deficit deteriorated in 4-6h postoperatively,high dose of MP was applied to treat spinal cord ischemic reperfusional（IR） injury.15 cases in control group accepted 20% mannitol during perioperation,with 125ml q6h.The neurological function between two groups were compared in term of JOA score.Result：No death was noted in two groups.All cases were followed up for 0.5-3.5 years.Average JOA score of two groups before surgery was 5.5±2.9 and 5.2±3.3 respectively,with no remarkable significance （P〉 0.05）.However,average JOA score of two groups had statistical difference at each time point postoperatively. Conclsion：MP has significant effect on patients with spinal cord injury in perioperative period.