甲基强的松龙在颈椎外科的围手术期应用

The application of perioperative methylprednisolone in decompression procedure of the cervical surgery

目的:观察颈椎外科手术围手术期应用甲基强的松龙(MP)对患者脊髓神经功能的影响,探讨最佳用药方案。方法:本组颈椎外科疾患共122例,年龄38～65岁,平均52.6岁。其中男性75例,女性47例。术前患者均伴有不同程度的神经功能损害。手术方式分为单纯前路减压66例,单纯后路减压35例,前后路联合减压21例。122例患者分为4组,A组31例,减压手术前半小时在持续心电监护下静脉滴注MP(30mg/kg)30min内滴完(冲击),术后1～3d按3mg/kg静滴MD;B组31例,冲击剂量为MP20mg/kg,余同A组;C组30例,仅术后1～3d按3mg/kg静滴MP;D组30例,仅术后1～3d每天予地塞米松10mg静滴。4组术后均予20%甘露醇脱水、洛赛克预防消化性溃疡、神经节苷酯营养神经治疗3～5d。对4组患者术后3d、1周、6个月时脊髓神经功能恢复率及并发症情况行统计学分析。结果:4组术前JOA评分无显著性差异(P>0.05)。术后3d、1周、6个月时,4组JOA评分均较术前有显著改善(P<0.01);A、B组神经功能恢复率优于C、D组(P<0.01),C组术后1周内优于D组(P<0.05),A、B组间无显著差异(P>0.05)。消化道溃疡、感染、心血管衰竭等并发症的发生率4组间无显著性差异(P>0.05)。结论:颈椎外科行减压手术时,围手术期使用MP可以改善脊髓神经功能预后,且减压手术前30min冲击剂量联合术后小剂量连续应用有明显优势,优于单独术后小剂量应用;同时消化道溃疡等并发症的发生率未显著增加;冲击剂量选择20mg/kg可能更为合理。

Objective：To evaluate the effects and the optimal strategy of methylprednisolone on perioperative neurological functions of the cervical surgery.Method： 122 cases of the cervical surgery with spinal cord compressed severely in Nanjing first hospital were enrolled.Among which,there were 75 male and 47 female.The average age was 52.6 years old （ranging from 38 to 65）.66 cases operated anteriorly,35cases posteriorly and 21 cases anteriorly with posteriorly.All the eases suffered different stage of spinal cord dysfunctions preoperatively.Before surgery,all the cases were divided into 4 groups according the strategies of MP＇s usage,group A （n=31）,30mg/kg MP （intravenously）,30 minutes before decompression electroeardio-monitoringly.3mg/kg MP （intravenously） qd for 3 days postoperatively.Group B（n=31）,20mg/kg MP（intravenously）,30 minutes before decompression eleetrocardio-monitoringly, 3mg/kg MP （intravenously） qd for 3 days postoperatively.Group C （n= 30）,only 3mg/kg MP （intravenously） qd for 3 days postoperatively.Group D （n=30）,only 10rag DXM（intravenously） qd for 3 days postoperatively.All cases were treated with dehydration（mannitol）,losee and neuronutritional medicine postoperatively.The patients＇ neurological functions were graded according the JOA score system preoperatively and in 3 days, 1 week and 6 months postoperatively.Complications were recorded during the application of MP.Resuit：Preoperative JOA scores among each group were of no statistical difference.The neurological functions of spinal cord among each group had improved obviously in 3 days,1 week and 6 months after surgery.The scores of group A and B were higher than those of group C and group D.The scores of group C were higher than those of group D in a week after surgery.Among each group no statistical difference was found in complications such as digestive ulcer,infection,cardiovascular system failure related to MP.Conelusion：High-dose administration of MP just 30 minutes before the decompression surgery in patients with spinal cord compressed severely can improve postoperative neurological function recovery rate significantly,and small does MP delivered intravenously after surgery can not improve neurological function well,and complications such as digestive ulcer,infection,and cardiovascular system failure related to MP are infrequent. The administration of 20mg/kg MP （intravenously）,30minutes before decompression mentioned above is safe and reasonable.