甲基强的松龙在脊髓型颈椎病围手术期的应用

目的观察脊髓型颈椎病患者围手术期应用甲基强的松龙（methyloprednisonlone,MP）预防脊髓神经功能损害的效果,探讨最佳用药方案。方法 2009年3月至2012年3月,36例确认为脊髓型颈椎病的患者随机分为A、B两组。采用颈前路减压植骨融合内固定或一期后、前路椎管减压内固定治疗,手术由同组医师完成。A组20例,减压前30min给予MP 1 000mg冲击,术后第1天起MP按照200mg、200mg、80mg、80mg逐日减量,共应用5d。B组16例,减压前不予冲击,减压即刻80mg及术后80mg/日静推共5d。如果减压后8h内出现脊髓损害加重的情况,立即按第三次全美急性脊髓损伤研究冲击方案执行,并排除血肿压迫等原因。两组手术开始后均给予20%甘露醇125mL静滴,术后按125mL/8h静滴,共4d。对两组术前、术后1周、术后3个月及术后6个月进行脊髓型颈椎病JOA评分。结果 A组有1例,B组有2例减压后8h内出现神经症状加重,按第三次全美急性脊髓损伤研究方案冲击后缓解;两组术前JOA评分比较,差异无统计学意义（P〉0.05）;术后1周、3个月、6个月两组JOA评分与术前比较均明显提高（P〈0.05）;术后1周JOA评分A组优于B组（P〈0.05）;术后3个月、6个月两组间比较,差异无统计学意义（P〉0.05）。结论脊髓型颈椎病围手术期应用MP可预防脊髓神经功能损害,促进近期神经功能恢复。术前宜权衡利弊,术中、术后仔细观察神经功能变化并及时处理,MP冲击应用并无必要。

Perioperative Application of Methylprednisonlone on Cervical Spondylotic Myelopathy in Perioperative Period

Objective To evaluate the effect and the optimal strategy of methyloprednisonlone（MP）on patients with cervical spondylotic myelopathy（CSM）during perioperative period.Methods 36cases diagnosed of CSM from March 2009to March 2012were randomized into 2groups.All cases were underwent anterior cervical decompression and fusion or posterior combined anterior canal decompression with fixation.1 000mg MP were administrated intravenously less than 30minutes before decompression with dose decreased day by day（200mg、200mg、80mg、80mg）in group A（n=20）.80mg were administrated intravenously after decompression at once in group B（n=16）and last for 5days. The patients with neurological deficit deteriorated in 8hpostoperatively,high dose of MP was applied according to NASCISⅢ.All cases accepted 20% mannitol prior to surgery,with 125mL q8hafter surgery for 4days.The neurological function of spinal cord were graded in term of JOA score system before operation 1week,3months and 6months after operation.Results 1case in group A and 2cases in group B with neurological deficit deteriorated were recovery with high dose of MP.Preoperative JOA scores between two groups had no statistical difference.Each group had improved obviously in 1week,3months and 6months after surgery.The scores of group A were higher than those of group B in 1week.However,average JOA scores of two groups had no statistical difference in 3months and 6months postoperatively.Conclusion For patients with cervical spondylotic myelopathy,MP used during perioperation can prevent spinal cord injury and improve neurological function recovery.However,these potential clinical benefits must be weighed against possible adverse effects.Decreasing dose of MP is associated with observation carefully during perioperation.