甲基强的松龙在胸椎管狭窄症围手术期的应用

Perioperative application of methylprednisolone for thoracic spinal stenosis

[目的]探讨大剂量甲基强的松龙(MP)在胸椎管狭窄症患者围手术期预防性应用的效果。[方法]对2003年7月～2007年12月40例胸椎管狭窄症采用单纯后路胸椎板切除术患者进行回顾性研究。根据围手术期是否应用MP分为两组:MP组,21例,术中脊髓减压前30min以MP30mg/kg冲击治疗(15min内滴完),45min后以5.4mg/(kg.h)维持用23h;对照组,19例,术中脊髓减压前给予地塞米松(DX)15mg静滴,术后10mg/d静滴,连续3d。术后3d、7d、3个月、12个月,按JOA脊髓功能评分标准评定神经功能改善率[(术后评分-术前评分)/(17-术前评分)×100%],观察并发症。[结果]术后3d时MP组与对照组神经功能改善率分别为(33.54±10.01)%、(28.29±8.73)%,有显著性差异(P<0.05),术后7d时分别为(58.34±8.98)%、(49.34±8.27)%,有显著性差异(P<0.05)。术后3个月及12个月两组患者神经功能改善率无显著性差异(P>0.05)。对照组有5例患者术后即刻出现神经功能障碍加重,而MP组未出现类似病例。[结论]围手术期应用大剂量MP对胸椎管狭窄症患者的脊髓功能有保护作用,提高手术的安全性,未增加严重不良反应的发生。

[Objective]To study the prophylactic effects of high dose methylprednisolone（MP） for perioperative surgical treatment of thoracic spinal stenosis.[Method]From July 2003 to December 2007,a retrospective study of 40 patients who underwent simply posterior thoracic vertebral canal decompression was made.The patients were divided into 2 groups according to the application of MP or none-MP at perioperation.Twenty-one patients in MP group were treated with MP stoss（30 mg/kg,iv 15 min） 30 min prior to the decompression and then 45 min later MP（5.4 mg/kg/h） was continuted for 23 hours.Nineteen patients in the control group were treated with dexamethasone（DX） 15 mg 30 min prior to the decompression and then DX（10 mg/d,iv） was given for 3 days after operation.Neurological function improvement rates were evaluated according to the JOA scores（postoperative JOA scores-preoperative JOA scores /17﹣preoperative JOA scores）×100% at 3d,7d,3d and 12 months after operation.Complication were observed.[Result]Neurological function recovery rates were 33.54±10.01% in MP group and 28.29±8.73% in the control group at 3 days after operation.The difference was found to be significant（P〈0.05）.Neurological function recovery rates were 58.34±8.98% in MP group and 49.34±8.27% in the control group at 7 days after operation.The difference was found to be significant（P〈0.05）.There was no significant difference in neurological function recovery rates between the two groups at 3 and 12 months（P〉0.05）.Neurological deficit was found in 5 in control group,while no one in the MP group.[Conclusion]High dose of MP used perioperatively for thoracic stenosis can protect spinal cord and improve operative security,while it does not increase serious adverse complications.