神經(jīng)根阻滯治療頸源性疼痛療效觀察及對(duì)外周血T細(xì)胞亞群的影響
發(fā)布時(shí)間：2018-11-14 16:18
【摘要】：目的:觀察超聲引導(dǎo)下選擇性頸神經(jīng)根阻滯方法治療頸源性疼痛的效果并探討其對(duì)于外周血T細(xì)胞亞群的影響。 方法:選擇2013年1月至2014年1月期間，行超聲引導(dǎo)下選擇性頸神經(jīng)根阻滯治療的頸椎間盤源性疼痛患者23例（實(shí)驗(yàn)組，A組）和行X線C型臂引導(dǎo)下頸椎旁阻滯治療的頸椎間盤源性疼痛患者23例（對(duì)照組，B組）。對(duì)A組和B組全部患者，采用疼痛數(shù)字評(píng)分法(NRS)進(jìn)行鎮(zhèn)痛效果評(píng)估，同時(shí)記錄患者術(shù)前、術(shù)后頸椎活動(dòng)度評(píng)分(ROM)、每周疼痛發(fā)作次數(shù)和每次疼痛發(fā)作持續(xù)時(shí)間的變化。全部患者在治療前24小時(shí)、治療后24小時(shí)、治療后3天、治療后7天取靜脈血2ml，應(yīng)用流式細(xì)胞儀檢測外周血T淋巴細(xì)胞亞群CD3+，CD4+和CD8+含量并進(jìn)行比較。 結(jié)果:（1）鎮(zhèn)痛效果方面，A組、B組兩組患者治療后與治療前比較，兩組患者治療前NRS分別為7.08±2.00和6.96±2.11，兩組患者治療后24小時(shí)NRS分別為1.98±1.55和2.35±2.87，治療后3天和治療后7天NRS分別為2.33±2.40和3.44±3.50，3.67±3.23和4.67±3.45，兩組患者治療后24小時(shí)、3天、7天NRS均顯著低于治療前NRS（P0.01）；A組、B組兩組患者治療前每周疼痛發(fā)作次數(shù)分別為11.08±17.77和9.66±12.46，治療7天后超聲下選擇性頸神經(jīng)根阻滯組和傳統(tǒng)盲探頸椎旁阻滯組疼痛發(fā)作次數(shù)分別為3.23±3.17和4.57±3.55，與治療前比較，，差異具有統(tǒng)計(jì)學(xué)意義（P0.05）；A組、B組兩組患者治療前疼痛發(fā)作持續(xù)時(shí)間分別為7.55±6.44h和8.08±7.45h，治療后疼痛發(fā)作持續(xù)時(shí)間分別為3.87±3.53h和4.07±3.75h，與治療前比較，差異具有統(tǒng)計(jì)學(xué)意義（P0.05）；A組、B組兩組患者治療前頸椎活動(dòng)度評(píng)分分別為2.69±2.12和2.93±2.11，治療后頸椎活動(dòng)度評(píng)分分別為1.51±0.63和1.48±0.51，與治療前比較，差異具有統(tǒng)計(jì)學(xué)意義（P0.05）；A組、B組兩組患者治療前頭頸部僵硬感覺率分別為86.96%和91.30%，治療后頭頸部僵硬感覺率分別為26.09%和52.17%，與治療前比較，差異具有統(tǒng)計(jì)學(xué)意義（P0.05）。（2）免疫學(xué)機(jī)理方面，外周血T淋巴細(xì)胞亞群含量與治療前比較，A組治療后24小時(shí)、治療后3天和治療后7天的CD3+、CD4+和CD8+含量均顯著高于治療前（P0.01或P0.05）；B組CD3+、CD4+和CD8+含量在治療后24小時(shí)和治療后3天均顯著高于治療前（P0.05），治療7天后與治療前比較，無統(tǒng)計(jì)學(xué)差異（P0.05）。（3）A組與B組兩組組間比較，治療后24小時(shí)，A組NRS與B組比較，差異無統(tǒng)計(jì)學(xué)意義（P0.05），治療后3天和治療后7天，A組NRS低于B組，兩組間比較，差異具有統(tǒng)計(jì)學(xué)意義（P0.05）；A組與B組兩組組間比較，治療后7天，A組疼痛發(fā)作次數(shù)和頭頸部僵硬感覺率低于B組，兩組間比較，差異具有統(tǒng)計(jì)學(xué)意義（P0.05）；A組與B組兩組組間比較，治療后24小時(shí)，A組外周血T淋巴細(xì)胞亞群CD3+，CD4+和CD8+含量與B組比較，差異無統(tǒng)計(jì)學(xué)意義，P0.05；治療后3天和治療后7天，A組外周血T淋巴細(xì)胞亞群CD3+，CD4+和CD8+含量均高于B組，兩組間比較，差異具有統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論:超聲下選擇性頸神經(jīng)根阻滯是治療頸間盤源性疼痛的一種有效方法,其療效優(yōu)于傳統(tǒng)的X線C型臂引導(dǎo)下頸椎旁阻滯方法，其作用機(jī)理可能與調(diào)節(jié)患者外周血T淋巴細(xì)胞亞群CD3+、CD4+和CD8+含量，提高患者提高細(xì)胞免疫能力相關(guān)。
[Abstract]:Objective: To observe the effect of selective cervical nerve root block in the treatment of cervical source pain and to study the effect of the selective cervical nerve root block on the subpopulation of peripheral blood T cells. Methods: From January 2013 to January 2014, 23 cases of cervical disc-source pain treated by selective cervical nerve root block under the guidance of ultrasound were selected (real 23 cases of cervical disc-source pain (control group, B) treated by the lateral block of the cervical disc under the guidance of the C-arm of the X-ray and the C-arm of the X-ray Group). A pain-based digital score (NRS) was used to evaluate the analgesic effect for all patients in the A and B groups, while recording the pre-operative, post-operative cervical motion score (ROM), the number of weekly pain episodes, and the duration of each pain Change: 24 hours before treatment, 24 hours after treatment, 3 days after treatment, 2 ml of venous blood for 7 days after treatment, and the content of CD3 +, CD4 + and CD8 + in peripheral blood T-lymphocyte subpopulations was detected by flow cytometry. Results: (1) The group A and group B were compared with the treatment before and after the treatment. The NRS in the two groups was 7.08, 2.00 and 6.96/ 2.11, respectively, and the NRS in the two groups was 1.98, 1.55 and 2.35, respectively. The NRS was 2.33, 2.40 and 3.44, 3.50, 3.67, 3.23 and 4.67, 3.45, respectively. The number of weekly pain in group A and group B was 11.08, 177.77 and 9.66, respectively. 12. 46. After 7 days of treatment, the number of pain episodes in the selective cervical nerve root block group and the traditional blind cervical block group was 3.23, 3.17 and 4.57, 3.55, respectively, and the difference was statistically significant (P0.05). 5) The duration of pre-treatment in group A and group B was 7.55, 6.44h and 8.08-7.45h, respectively, and the duration of post-treatment pain was 3.87, 3.53h and 4.07-3.75h, respectively. In group A and group B, the degree of activity of the anterior cervical spine was 2.69, 2.12 and 2.93/ 2.11, respectively. The scores of the posterior cervical movement were 1.51, 0.63 and 1.48, 0.51, respectively. The stiffness of head and neck in group A and group B was 86. 96% and 91. 30%, respectively. The stiffness of head and neck after treatment was 26. 09% and 52. 17%, respectively. (2) The content of CD3 +, CD4 + and CD8 + in peripheral blood T-lymphocyte subgroup was significantly higher than that before treatment (P0.01 or P0.05). The content of CD3 +, CD4 + and CD8 + in the treatment group was significantly higher than that before treatment (P0.05). (0. 05). (3) There was no significant difference between group A and group B in group A and group B (P0.05). There was no significant difference between group A and group B (P0.05). In group A and group B, the number of pain and head and neck stiffness in group A were lower than that of group B, and the difference between group A and group B was statistically significant (P0.05); and group A and group B were compared and treated in group A and group B. The content of CD3 +, CD4 + and CD8 + in peripheral blood T-lymphocytes in group A was significantly higher than that in group B after 24 hours, and the content of CD3 +, CD4 + and CD8 + in peripheral blood of group A was higher than that of group B after 3 days after treatment and 7 days after treatment. The difference was statistically significant between the two groups (P Conclusion: The selective cervical nerve root block under the condition of ultrasound is an effective method to treat the source pain of the cervical disc, and the curative effect is superior to that of the traditional X-ray C-type arm under the guidance of the cervical lateral block, and the mechanism of action may be the same as that of the T-lymph node in the peripheral blood of the patient. Increased number of CD3 +, CD4 + and CD8 + in the subpopulations of the cells, and increased the number of patients
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R614.4
本文編號(hào)：2331675
[Abstract]:Objective: To observe the effect of selective cervical nerve root block in the treatment of cervical source pain and to study the effect of the selective cervical nerve root block on the subpopulation of peripheral blood T cells. Methods: From January 2013 to January 2014, 23 cases of cervical disc-source pain treated by selective cervical nerve root block under the guidance of ultrasound were selected (real 23 cases of cervical disc-source pain (control group, B) treated by the lateral block of the cervical disc under the guidance of the C-arm of the X-ray and the C-arm of the X-ray Group). A pain-based digital score (NRS) was used to evaluate the analgesic effect for all patients in the A and B groups, while recording the pre-operative, post-operative cervical motion score (ROM), the number of weekly pain episodes, and the duration of each pain Change: 24 hours before treatment, 24 hours after treatment, 3 days after treatment, 2 ml of venous blood for 7 days after treatment, and the content of CD3 +, CD4 + and CD8 + in peripheral blood T-lymphocyte subpopulations was detected by flow cytometry. Results: (1) The group A and group B were compared with the treatment before and after the treatment. The NRS in the two groups was 7.08, 2.00 and 6.96/ 2.11, respectively, and the NRS in the two groups was 1.98, 1.55 and 2.35, respectively. The NRS was 2.33, 2.40 and 3.44, 3.50, 3.67, 3.23 and 4.67, 3.45, respectively. The number of weekly pain in group A and group B was 11.08, 177.77 and 9.66, respectively. 12. 46. After 7 days of treatment, the number of pain episodes in the selective cervical nerve root block group and the traditional blind cervical block group was 3.23, 3.17 and 4.57, 3.55, respectively, and the difference was statistically significant (P0.05). 5) The duration of pre-treatment in group A and group B was 7.55, 6.44h and 8.08-7.45h, respectively, and the duration of post-treatment pain was 3.87, 3.53h and 4.07-3.75h, respectively. In group A and group B, the degree of activity of the anterior cervical spine was 2.69, 2.12 and 2.93/ 2.11, respectively. The scores of the posterior cervical movement were 1.51, 0.63 and 1.48, 0.51, respectively. The stiffness of head and neck in group A and group B was 86. 96% and 91. 30%, respectively. The stiffness of head and neck after treatment was 26. 09% and 52. 17%, respectively. (2) The content of CD3 +, CD4 + and CD8 + in peripheral blood T-lymphocyte subgroup was significantly higher than that before treatment (P0.01 or P0.05). The content of CD3 +, CD4 + and CD8 + in the treatment group was significantly higher than that before treatment (P0.05). (0. 05). (3) There was no significant difference between group A and group B in group A and group B (P0.05). There was no significant difference between group A and group B (P0.05). In group A and group B, the number of pain and head and neck stiffness in group A were lower than that of group B, and the difference between group A and group B was statistically significant (P0.05); and group A and group B were compared and treated in group A and group B. The content of CD3 +, CD4 + and CD8 + in peripheral blood T-lymphocytes in group A was significantly higher than that in group B after 24 hours, and the content of CD3 +, CD4 + and CD8 + in peripheral blood of group A was higher than that of group B after 3 days after treatment and 7 days after treatment. The difference was statistically significant between the two groups (P Conclusion: The selective cervical nerve root block under the condition of ultrasound is an effective method to treat the source pain of the cervical disc, and the curative effect is superior to that of the traditional X-ray C-type arm under the guidance of the cervical lateral block, and the mechanism of action may be the same as that of the T-lymph node in the peripheral blood of the patient. Increased number of CD3 +, CD4 + and CD8 + in the subpopulations of the cells, and increased the number of patients
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R614.4
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