糖皮质激素在退变性颈脊髓病围手术期应用进展

Advances in Application of Glucocorticoids in Perioperative Degenerative Cervical Myelopathy

退变性颈脊髓病是导致成人脊髓功能障碍的最常见原因,现阶段减压手术已成为其缓解症状的主要方法。不论是前路,还是后路,减压手术的疗效已被证实。但在关注手术疗效的同时,其并发症也越来越受关注。糖皮质激素围手术期应用是否能够降低退变性颈脊髓病减压手术并发症的发生率一直是个争议的话题。在基础研究领域已证实,减压术后出现神经功能下降与缺血-再灌注损伤和免疫系统激活有关,并且甲泼尼龙可以促进长期受压的脊髓运动功能恢复,降低减压手术围手术期神经并发症,并在不破坏循环免疫细胞组成的情况下保护神经元细胞,进而建议在退变性颈脊髓病减压手术围手术期应用甲泼尼龙。但是在临床研究中,尚缺乏高等级证据。我国多名专家共同完成了《肾上腺糖皮质激素围手术期应用专家共识(2017版)》,为我国医师在围手术期应用糖皮质激素提供规范和指导。但是该共识主要是针对于一般共性手术的围手术期用药,对于退变性颈脊髓病的围术期应用并未详述。本文结合糖皮质激素在退变性颈脊髓病围手术期应用的相关文献,对其在术后吞咽困难、辅助镇痛、C_5神经根麻痹等方面的作用进行综述。

Degenerative cervical myelopathy is the most common cause of spinal cord dysfunction in adults.The efficacy of decompression surgery has been demonstrated in both anterior and posterior approaches.While paying attention to the curative effect of surgery,its complications are also getting more and more concern.Whether perioperative glucocorticoid use can reduce the incidence of decompression complications in degenerative cervical myelopathy has been a controversial topic.In the field of basic research,neurological decline after decompression has been confirmed to be related to ischemia-reperfusion injury and immune system activation.In addition,methylprednisolone reduces perioperative neurological complications following decompressive surgery for degenerative cervical myelopathy by protecting neurons from inflammation,without compromising the composition of circulating immune cells.However,in clinical studies,there is still a lack of high-level evidence.Experts in China jointly completed the expert consensus on perioperative application of adrenal glucocorticoids(2017 version),which provides norms and guidance for Chinese physicians in the application of perioperative glucocorticoids.However,this consensus mainly aims at general surgery,and the perioperative application of degenerative cervical myelopathy is not detailed.In this review,the author summarized the advances of glucocorticoids in dysphagia,auxiliary analgesia and C5 nerve root palsy,in perioperative period of Degenerative cervical myelopathy,combined with relevant literature.