腰椎手术后应用小剂量甲基强的松龙的安全性观察

The clinical safety of small dosage methylprednisolone applied after operation of lumbar surgery

目的:观察腰椎手术后静脉应用小剂量甲基强的松龙(MP)的安全性。方法:2007年1月至2008年1月因单节段腰椎管狭窄症在我院实施椎管减压、椎弓根螺钉内固定、植骨融合手术的患者38例,其中22例在手术后应用小剂量MP预防术后神经根水肿(MP组),16例未应用MP者作为对照组。观察两组患者术后72h时的血压变化情况,术后第1、3、7天的日平均体温、凝血酶原时间和伤口愈合情况,并对所有患者术前3d及术后7d时进行大便潜血和双下肢血管彩超检查。结果:MP组术后72h血压较入院时血压平均增加6.7%,对照组增加8.6%,两组比较无显著性差异(P=0.229);MP组术后第1、3、7天的日平均体温分别为37.5℃±0.4℃、37.2℃±0.3℃、36.8℃±0.3℃,对照组分别为37.7℃±0.3℃、37.4℃±0.4℃、37.0℃±0.2℃,两组比较无显著性差异;MP组术后第1、3、7天凝血酶原时间分别为9.7±0.8s、12.6±1.2s、10.3±1.4s;对照组分别为10.1±0.5s、11.9±0.9s、11.2±0.8s,两组比较无显著性差异。两组患者伤口均愈合良好,无延迟拆线和伤口感染病例。MP组术前大便潜血检出为0/22,双下肢血栓检出为3/22,术后7d大便潜血检出为1/22,而双下肢血栓检出为4/22;对照组术前大便潜血检出为0/16,双下肢血栓检出为2/16,术后7d大便潜血检出为1/16,同时双下肢血栓检出为3/16,两组无显著性差异。结论:腰椎手术后静脉应用小剂量MP安全性好,不会增加并发症的发生率。

Objective：To evaluate the clinical safety of the application of small dosage methylprednisolone （MP） after operation of lumbar surgery to prevent edema of spinal cord and nerve root.Method：Of 38 cases underwent treatment by single-segment decompression and pedicle screws fixation with bone graft fusion from Janurary 2007 to Janurary 2008,22 patients （MP group） were treated with intravenous MP of small dosage and the 16 cases（control group） had no intravenous MP treatment at the same period.The variation of blood pressure after 72 hours of operation was recorded in two groups.Besides ,the morning body temperature and prothrombin fime（PT） were tested at 1,3,7 days of post-operation and the wound healing results were compared in both groups,the occult blood（OB） test and colorful ultrasonic examination of bilateral lower extremity vessels were performed for all patients 3 days before operation and 7 days after operation.Result：The blood pressure increased,6.7% in MP group and 8.6% in the control group after 72 hours of operation,there was no significant differences in the variation of the blood pressure between the groups （P=0.229）.The morning body temperature at 1,3,7 days of post-operation were 37.5℃±0.4℃,37.2℃±0.3℃,36.8℃±0.1℃in MP group and 37.7℃±0.3℃,37.4±0.4℃,37.0℃±0.2℃ in control group without significant difference.At the same time points the PT were 9.7±0.8s,12.6±1.2s,10.3±1.4s in MP group and 10.1±0.5s,11.9±0.9s,11.2±0.8s in control group.The wound recovery was the same as good in both groups.No case had a delayed sutures out and incision infection.The result of OB test was 0/22 and the positive rate of bilateral lower extremity vessel thrombus was 3/22 in MP group while in control group it was 0/16 and 2/16 before operation.On the 7th day after operation in MP group the result of OB test was 1/22 and the positive rate of bilateral lower extremity vessel thrombus was 4/22 while in control group it was 1/16 and 3/16.There was no significant difference in all data of two groups by the statistic analysis.Conclusion：It is safe to use a small dosage of MP intravenously after operation of lumbar surgery as it will not increase the incidence of the complications.