甲基强的松龙在脊髓型颈椎病手术治疗中的应用

The Clinical Evaluation of Methylprednisolone on the Improvement of Postoperative Neurological Functions of Cervical Spondylotic Myelopathy

目的:探讨甲基强的松龙(MP)在脊髓型颈椎病(CSM)患者围手术期应用的效果。方法:62例CSM患者根据围手术期是否应用MP分为2组。MP治疗组:32例,根据患者体重,术中脊髓减压前15min以MP1500mg或2000mg冲击,15min内滴完,45min后继以2000mg MP维持用药23h;对照组:30例,术中脊髓减压前15min给予地塞米松10mg静脉点滴,术后20%甘露醇250mL+地塞米松5mg静脉点滴,Bbd×3d。术后3d、7d、1个月和6个月按JOA评分标准评定两组患者的神经功能改善率[(术后JOA评分-术前JOA评分)/(17-术前JOA评分)×100%],并对数据进行t检验。结果:术后3d两组患者神经功能改善率比较差异无统计学意义(P>0.05),术后7d时MP组与对照组神经功能改善率分别为(67.93±9.45)%、(48.77±8.86)%(P<0.05),术后1个月分别为(74.25±7.56)%、(60.85±9.66)%(P<0.05),术后6个月分别为(83.26±9.54)%、(70.67±8.99)%(P<0.05)。术后MP组2例出现应激性溃疡,经治疗痊愈;对照组有5例出现反跳现象。结论:围手术期应用MP对于CSM患者的脊髓神经功能有保护作用。

Objective：To evaluate the clinical effects of perioperative administration of Methylprednisolone（MP） on the improvement of postoperative neurological functions of cervical spondylotic myelopathy（CSM）. Methods： Sixty-two patients with CSM were divided into 2 groups according to application of MP or not in perioperation. 32 patients in MP group were treated with MP 15rain prior to decompression, with 1500mg or 2000mg according to weight within 15min. Then after 45min interval, sequenced with 2000mg MP in the following 23h; 30 patients in the control group were treated with intravenous dexamethasone 10mg 15min prior to decompression and then sequenced with intravenous dexamethasone 5mg in 20% mannital 250ml, Bid × 3d. Neurological function improvement rates were evaluated according to the JOA scoresF（postoperative JOA scores-preopera- tive JOA scores）/（17-preoperative JOA scores） × 100% at 3d,7d,lmonth and 6 months postoperation in both groups. Resuits： There were no statistical difference of neurological function improvement rate between the two groups at 3 d post-operation（P〉0.05）. Neurological function improvement rate were （67, 93 ± 9.45）% in MP group and （48.77 ± 8.86）% in the control group at 7d post-operation（P〈0.05）. Neurological function improvement rate ＇were （74. 25 ± 7. 56）%in MP group and （60.85±9.66）% in the control, group at 1 month post-operation（P〈0.05）. Neurological function improvement rate were （83.26 ± 9.54）% in MP group and（70.67±8.99）% in the control group at 6 month post-operation（P〈0.05）. Conclusion： Perioperative administration of MP in patients with CSM can improve operative security and neurological function recovery rate.