甲基强的松龙在脊髓型颈椎病围手术期的应用探讨_医学论文.docVIP

甲基强的松龙在脊髓型颈椎病围手术期的应用探讨_医学论文 甲基强的松龙在脊髓型颈椎病围手术期的应用探讨_医学论文 【摘要】 目的 观察甲基强的松龙（MP）对脊髓型颈椎病患者术后神经功能的影响，并探讨MP的最佳用药方案。方法 手术治疗的脊髓型颈椎病患者75例，均采用颈前路减压术，随机分为4组：术中大剂量MP组（A组，n=20）、术后大剂量MP组（B组，n=22）、术后小剂量MP组（C组，n=18）和地塞米松对照组（D组，n=15）。根据JOA计分法，分别于术前及术后1天、2周、3个月定量评定患者的神经功能，记录并统计相关并发症。结果 术前各组JOA评分无统计学差异（Pgt0.05），术后1天、2周、3个月A、B组分别和C、D组比较差异有统计学意义（P＜0.05）；A组与B组比较差异无统计学意义（Pgt0.05）；各组间并发症的发生率无统计学差异（Pgt0.05）。结论 术中及术后30 min快速静脉输注MP 1 000 mg能够显著改善脊髓型颈椎病患者术后及近期神经功能，术后小剂量应用MP 则无明显改善效果。 【关键词】 甲基强的松龙 脊髓型颈椎病 神经功能 用药方案 Abstract: Objective To investigate the effects of high dose methylprednisolone (MP) on the postoperative recovery of neurological functions related to cervical spondylotic myelopathy (CSM). Methods 75 patients with CSM undergoing cervical spine surgery were randomly divided into four groups: group A (intraoperative high dose MP)， group B (postoperative high dose MP)， group C (postoperative low dose MP) and group D (dexamethasone control group). The neurological recovery was evaluated by the JOA scoring, with complications noticed alongside. Results Statistical analysis showed that there were no significant differences in JOA score between groups before the surgery (Pgt0.05). While two weeks and three months after operation, significant improvement of neurological function was found in groups A and B, as compared with groups C and D (0.05).There were no significant difference in JOA between groups A and B, nor any in complications encountered between the groups (Pgt0.05). Conclusion High dose MP during or 30 min after the surgery in patients with CSM can improve neurological recovery rate significantly, while low dose MP has no such effect. Key words: methylprednisolone cervical spondylotic myelopathy neurological function； strategies 甲基强的松龙（methylprednisolone,MP）在脊髓急性损伤的治疗中已得到广泛的应用，其疗效已被大量的临床和实验研究所证实［1－2］，并且美国急性脊髓损伤研究（NASCIS）Ⅱ、Ⅲ期临床试验［3－4］所推荐的用法和剂量也越来越被接受，其作用机制也已逐渐明确。 近年来有学者将MP应用于慢性压迫型颈椎病的外科治疗中［5］，用以促进术后神经功能的恢复，并取得了初步的成果。然而，脊髓慢性压迫性疾病无论从发病原因、发病机制，还是病理改变等方面均与急性损伤明显不同。目前国内外关于MP在脊髓