甲基强的松龙在脊髓缺血再灌注损伤预防的应用

目的:探讨甲基强的松龙(MP)在脊髓缺血再灌注损伤中预防的应用价值。方法:回顾性分析因颈、胸椎管狭窄症行椎管减压术患者488例。230例于减压术前30min给予MP1000mg,15min内滴完,减压术后第1d起每日MP递减200mg,术后第5d停药;对照组258例术前常规应用地塞米松20mg静脉滴注,连续5～7天后改为口服,每日三次,每次0.75mg,维持两周。结果:19例于减压后2～4h突然出现减压平面以下感觉、运动进行性减退至消失,同时双下肢各种生理反射以及术前存在的病理反射均消失,经影像学及相关检查诊断为脊髓缺血再灌注损伤,其中实验组4例,对照组15例。结论:颈、胸椎管狭窄症行椎管减压术前应用甲基强的松龙在预防术后脊髓缺血再灌注损伤方面优于术前常规应用地塞米松。

Objective： To investigate the preventional application value of methylp rednisolone（MP）on patients with ischemia-reperfusion injury. Method： Retrospective study were carried out on 488 cases with ischemia-reperfusion injury,230 cases were administrated with 1000 mg MP within 15 mins half an hour beforedecompression operation, from the 1st day after operation reduce the dose of MPin 200rag each day ,and stop in 5th day after operation. 258 case in control group were administrated dexamethasone（Dex）with 20mg before operation as conventional,and continuously used in 5-7days,changed to by swallow Dex with 0.75mg three times a day keep 2 weeks. Result： 19cases suddenly lost feeling and active ability has gradually reduce or even lost under the decompression segment in 2-4 hours after operation,at the same time,the physiological and pathologicalreflection which exist in both lower limbs are disappeared.There are 4 cases in test group and 15 cases in control group diagnosed as ischemia-reperfusion injury by medical imageology and the other related examination. Conclusion： Thepatients with cervical and thoracic spinal cord injury which were administrated MP before decompression operation to prevent ischemia-reperfusion injury are better than that used Dex before operation.