【摘要】：目的探討普瑞巴林聯(lián)合塞來昔布治療腰椎間盤突出癥經(jīng)皮內(nèi)鏡術(shù)后神經(jīng)病理性疼痛的療效。方法2014年1月—6月采用經(jīng)皮內(nèi)鏡椎板間入路腰椎間盤髓核摘除術(shù)治療178例腰椎間盤突出癥患者,其中90例符合選擇標準納入研究,并按照性別、病程、病變節(jié)段、吸煙史以及術(shù)前Leeds神經(jīng)病理性癥狀和體征評分(LANSS)、Oswestry功能障礙指數(shù)(ODI)評分,等配比分成A、B、C組(n=30);試驗期間9例患者因未完成研究或失訪剔除研究。每組各27例納入最終分析。3組患者性別、年齡、身高、體質(zhì)量指數(shù)、病變節(jié)段、病程、吸煙史以及術(shù)前LANSS評分、ODI評分、疼痛視覺模擬評分(VAS)、手術(shù)時間等一般資料比較,差異均無統(tǒng)計學(xué)意義(P0.05),具有可比性。3組患者均從術(shù)前3 d至術(shù)后14 d口服塞來昔布;A組術(shù)前3 d開始加用普瑞巴林至術(shù)后14 d,B組術(shù)后14 d內(nèi)加用普瑞巴林。服藥期間觀察患者藥物不良反應(yīng)發(fā)生情況。術(shù)前及術(shù)后1 d、1個月、3個月行靜息及活動狀態(tài)下VAS評分以及LANSS評分;術(shù)前及術(shù)后1、3個月行ODI評分;術(shù)后3個月記錄發(fā)生神經(jīng)病理性疼痛例數(shù),采用改良Macnab標準評價臨床療效。結(jié)果試驗期間,在增加普瑞巴林劑量時A組1例出現(xiàn)嚴重頭暈,B組1例出現(xiàn)嗜睡,均停藥并剔除研究;另有2例(A組1例、C組1例)出現(xiàn)口干,B組1例出現(xiàn)乏力,對癥處理后癥狀緩解。術(shù)后1 d,A組LANSS評分、靜息及活動狀態(tài)下VAS評分均低于B、C組(P0.05);術(shù)后1個月,A、B組LANSS評分、ODI評分、靜息及活動狀態(tài)下VAS評分均低于C組(P0.05);術(shù)后3個月,A、B組LANSS評分、ODI評分及活動狀態(tài)下VAS評分均低于C組(P0.05);其余各時間點以上指標組間比較差異均無統(tǒng)計學(xué)意義(P0.05)。術(shù)后3個月,7例患者發(fā)生神經(jīng)病理性疼痛,其中A組1例(3.7%)、C組6例(22.2%),A、B組與C組比較差異有統(tǒng)計學(xué)意義(P0.05),A、B組間比較差異無統(tǒng)計學(xué)意義(P0.05)。按照改良Macnab評價標準,A、B、C組優(yōu)良率分別為92.6%、88.9%、85.2%,3組間比較差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論腰椎間盤突出癥經(jīng)皮內(nèi)鏡術(shù)圍手術(shù)期口服普瑞巴林聯(lián)合塞來昔布能減輕患者術(shù)后疼痛程度,降低神經(jīng)病理性疼痛發(fā)生率。術(shù)前口服普瑞巴林能減少術(shù)后急性神經(jīng)病理性疼痛的發(fā)生。
[Abstract]:Objective to investigate the therapeutic effect of prapamil combined with celecoxib in the treatment of neuropathic pain after percutaneous endoscopic lumbar disc herniation (LIDP). Methods from January to June, 2014, 178 patients with lumbar disc herniation were treated by percutaneous endoscopic interlaminar discectomy, 90 of which were included in the study according to sex, course of disease and segment of lesion, and 90 of them were included in the study according to sex, course of disease and pathological segment. Smoking history and preoperative Leeds neuropathic symptoms and signs score (LANSS), Oswestry dysfunction index (ODI) score, equal score was A, B, C group (n = 30); During the trial, 9 patients were excluded because of incomplete study or missed follow-up. Gender, age, height, body mass index, lesion segment, course of disease, smoking history and preoperative LANSS score, ODI score and pain visual analogue score (VAS),) were included in the final analysis of 27 cases in each group. There was no significant difference in operation time and other general data (P0.05). Three groups of patients were taken celecoxib orally from 3 days before operation to 14 days after operation, and all the three groups were treated with celecoxib orally from 3 days before operation to 14 days after operation. The patients in group A received prednisine from 3 days before operation to 14 days after operation, and those in group B received prednisone within 14 days after operation. The incidence of adverse drug reactions was observed during the medication period. Before and 1 day, 1 month and 3 months after operation, VAS score and LANSS score were performed at rest and activity, ODI score was performed before operation and 1 month and 3 months after operation. Cases of neuropathic pain were recorded 3 months after operation, and the clinical efficacy was evaluated by modified Macnab criteria. Results during the experiment, one case in group A developed severe dizziness and one case in group B developed somnolence when the dosage of primadipine was increased. All patients were stopped and removed from the study. The other 2 cases (1 case in group A and 1 case in group C) developed dry mouth and 1 case in group B showed fatigue. The symptoms were relieved after treatment. On the 1st day after operation, the LANSS score, VAS score at rest and activity in group A were lower than those in group B, group C (P0.05), and the scores of LANSS, ODI, VAS at rest and activity in group A and B were lower than those in group C at the first month after operation (P0.05). At 3 months after operation, the LANSS score, ODI score and VAS score in group A and B were lower than those in group C (P0.05), but there was no significant difference in the other indexes above each time point (P0.05). Three months after operation, 7 patients developed neuropathic pain, including 1 case in group A (3.7%), C), 6 cases (22.2%) in group A, and there was significant difference between group A and group C (P0.05), A,). There was no significant difference between groups B (P0.05). According to the improved Macnab criteria, the excellent and good rates of A, B and C groups were 92.6%, 88.9% and 85.2%, respectively. There was no significant difference among the three groups (P0.05). Conclusion Peri-operative oral prednisone combined with celecoxib can relieve postoperative pain and reduce the incidence of neuropathic pain in patients with lumbar disc herniation. Oral prednisone before operation can reduce the incidence of postoperative acute neuropathic pain.
【作者單位】： 四川大學(xué)華西醫(yī)院骨科;廣西壯族自治區(qū)人民醫(yī)院骨科;
【分類號】：R687.3

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