甲基强的松龙预防脊髓缺血再灌注损伤的临床价值

目的：探讨甲基强地松龙（MP）预防脊髓缺血再灌注损伤的应用价值。方法：回顾分析488例因颈、胸椎管狭窄症行椎管减压术患者临床资料。230例于减压术前30min静脉滴注MP1000mg,15min内滴完,减压术后第1d起每日MP用量递减200mg,术后第5d停药;对照组258例术前静脉滴注地塞米松20mg,连续5～7d后改为口服,每日3次,每次0.75mg,维持2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应用地塞米松。

Effect of Methylprednisolone on the Spine Cord Ischemic Reperfusion Injury

Objective： To investigate the preventional application value of methylp rednisolone （MP） on patients with ischemia- reperfusion injury. Methods： Retrospective study were carried out on 488 cases with spine cord isehemia-reperfusion injury,230 cases were administrated with 1000 mg MP within 15 mins half an hour before decompression operation, from the 1st day after operation reduce the dose of MPin 200mg each day,and stop on the 5th day after operation. Two hundred fifty-eitght case in control group were administrated dexamethasone （Dex） with 20mg before operation as conventional, and continuously for 5 to 7days. Then Dex was taken orally 0.75mg three times a day for 2 weeks. Results： Ninteen cases suddenly lost feeling and active ability under the decompression segment in 2-4 hours after operation, at the same time, the physiological and pathologicalreflec tion which exist in both lower limbs were disappeared. There were 4 cases in test group and 15 cases in control group were diagnosed as ischemia-reperfusion injury by medical imageology and the other related examinations. Conclusion：Thepatients with cervical and thoracic spinal cord injury which were administratedMP before decompression operation to prevent ischemia reper fusion injury are better than that used Dex before operation. The effent of Mp administered befor deampression operation superior to Dex to prevent is chenia-repprfusion injury for cervical and thoracic spinal cord injury patients.