甲泼尼龙在颈椎前路减压术中的应用  

Clinical significance of perioperative methylprednisolone on anterior cervical decompression operation

作　　者：刘建东[1] 卢承志[1] 林斌[2] 周亮[2] 张文龙[1] 姚猛飞[1] 

机构地区：[1]解放军175医院麻醉科,福建漳州363000 [2]解放军175医院骨科,福建漳州363000

出　　处：《东南国防医药》2013年第4期355-357,共3页Military Medical Journal of Southeast China

摘　　要：目的探讨甲泼尼龙(MP)在脊髓型颈椎病(CSM)前路减压术中的应用价值。方法选择行颈椎前路减压术的CSM 50例,随机分为甲泼尼龙组(MP组)和对照组(C组),每组25例。MP组给予MP 30 mg/kg,C组予与等容量生理盐水。分别于麻醉诱导前(T1),术后1 h(T2),术后6 h(T3),术后24 h(T4)抽取静脉血,用酶联免疫吸附法(ELISA)测定血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及超氧化物歧化酶(SOD)的浓度。结果两组患者血浆TNF-α、IL-6的浓度,在T2～T4各时点与术前比较均明显增加(P<0.01),SOD浓度在T2、T3时点均明显高于T1时点(P<0.05);MP组血浆TNF-α和IL-6浓度T2～T4时点明显低于C组(P<0.01),SOD浓度T2、T3时点明显高于C组(P<0.05)。结论甲泼尼龙能抑制颈椎前路减压术中血浆TNF-α和IL-6的释放,保护SOD活性,从而减少再灌注损伤,减轻炎症反应。Objective To investigate the effects of methylprednisolone（MP） on patients with cervical spondylotic myelopathy（CSM） underwent anterior decompression.Methods Fifty patients scheduled for elective anterior decompression were randomly divided into two groups of 25 each： control group（C） and methylprednisolone group（MP）.Group MP received methylprednisolone 30 mg / kg and group C received same volume of normal saline instead of methylprednisolone as control.Blood samples were taken from vein for determination of plasma TNF-α,IL-6 and SOD concentrations before induction of anesthesia（T1）,1 h after（T2）,6 h after（T3） and 24 h（T4） after termination of operation.All of these was estimated by enzyme-linked immunosorbent assay（ELISA）.Results There was no significant difference between two groups in plasma TNF-α,IL-6 and SOD level at T1.The level of TNF-α,IL-6 at T2-T4 and SOD at T2-T3 was significantly increased compared with that before operation in both groups.However,the plasma concentrations of TNF-α and IL-6 were significantly lower at T2-T4 while the concentration of SOD was significantly higher at T2-T3 in group MP than those in group C.Conclusion Methylprednisolone can reduce the increased amplitude of plasma levels of TNF-α and IL-6,whereas enhance the increased amplitude of the plasma SOD levels in anterior cervical decompression operation.In other words,Methylprednisolone posseses the effect to decrease ischemical reperfusion injury and down-regulate inflammatory response during operation.

关 键 词：脊髓型颈椎病 甲泼尼龙 颈椎前路减压术 再灌注损伤 炎症反应 

分 类 号：R687.3[医药卫生—骨科学]