甲强龙联合专科护理对高颈段脊髓肿瘤治疗的影响

Effect of methylprednisolone combined with specific nursing on high cervical spinal cord tumors

目的 探讨甲强龙联合专科护理对高颈段脊髓肿瘤治疗的影响. 方法 选择我院神经外科2009 年1月至2013年12月诊治的284例高颈段脊髓肿瘤患者,对其护理策略、护理方法进行改良和完善,将284例患者随机分为专科护理组（对照组,未给予甲强龙）和联合护理组（观察组,同时给予甲强龙）,通过增强CT、MR动态扫描、生命质量评价结合长期随访,随时评估高颈段脊髓肿瘤患者的病情和预后. 结果 283 例患者平稳度过水肿高发期,1例患者因术后出现呼吸机麻痹经抢救无效后死亡,其中联合护理组患者的脊髓水肿参数—病变周围血容量（ rCBV）、平均通过时间（ MMT）、脊髓血管表面通透性（ PS值）、平均扩散系数（ ADC值）等较对照组均降低,差异有统计学意义（P〈0. 05）. 所有患者度过水肿期后出现脑脊液漏12例,术后感染5例,椎管内血肿3例. 出院后持续对患者随访1~5年,283 例患者原有症状都得到缓解或治愈,其中联合护理组患者的生存质量评分—barthel指数、FIM量表、QIF指数、功能活动调查表FAQ、颈椎JOA评分较对照组均提高,差异有统计学意义（P〈0. 05）. 结论 甲强龙联合专科护理是减少高颈段脊髓肿瘤患者术后并发症、获得良好预后的重要保证.

Objective To observe the effect of methylprednisolone combined with specific nursing on high cervical spinal cord tumors. Methods The nursing policy and methods on 284 cases with high cervical spinal cord tumors in the department of neurosurgery of our hospital had been improved from January 2009 to December 2013. Meanwhile,the patients were randomly divided into specific nursing group （ control group,without methylpred-nisolone） and combination group （specific nursing combined with methylprednisolone）. The severity and prognosis of patients with high cervical spinal cord tumors were assessed through enhanced CT,dynamic MR imaging,long-term fol-low-up of quality of life. Results Two hundreds and eighty-three patients recovered from edema period smoothly,but a patient was dead because of postoperative respiratory paralysis. The parameters （ included rCBV,MMT,PS and ADC） in spinal cord edema in combination group were lower than those of control group （P〈0. 05）. After operation,there were 12 cases with cerebrospinal fluid leakage,5 cases with postoperative infection,and 3 cases with intraspinal hematoma. During the follow-up of the quality of life from 1 to 5 years,the original symptoms of 283 patients all had been relieved or cured. The score of quality of life including Barthel index,index of FIM scales,QIF,functional activity questionnaire （ FAQ ） and cervical JOA score in combination group were better than those of control group （P〈0. 05）. Conclusion Methylprednisolone combined with specific care is an important guarantee to reduce postop-erative complications and improve the prognosis in patients with high cervical spinal cord tumors.