陈旧性胸腰段脊髓损伤中枢性疼痛的发生机制探讨  

Approach to the occurrence mechanism of spontaneous pain of long term central pain in spinal cord injury

作　　者：戴红[1] 谭郁玲[2] 张洪[3] 王春艳[3] 张立军[3] 肖忠新[1] 赵峰[1] 

机构地区：[1]首都医科大学康复医学教研室 [2]北京市神经外科研究所神经生理室 [3]唐山市截瘫疗养院

出　　处：《中国康复医学杂志》2001年第4期212-215,共4页Chinese Journal of Rehabilitation Medicine

基　　金：北京市自然科学基金项目 ;项目号 :7982 0 16

摘　　要：目的 :探讨脊髓损伤 (spinalcordinjury ,SCI)中枢痛 (centralpain ,CP)的机制。 方法 :采用莫克吉尔疼痛问卷(MPQ) ,视觉模拟评分法 (VAS)和体感诱发电位 (SEP)对 12例陈旧性胸腰段SCI的中枢性疼痛的自发痛进行了观察 ,并采用以降低中枢兴奋性为主的耳压疗法、生物反馈和经皮神经电刺激 /震动刺激结合的综合疗法对其进行了实验性治疗和治疗前后评测。结果 :①按其各自的特点将陈旧性SCI的中枢性疼痛的自发痛分为 3类、2型 ;②发现陈旧性SCI的中枢性疼痛中自发间断痛发作时 (B) ,持续麻木痛存在时 (A)及无痛时 (N) ,体感诱发电位 (SEP)中成分波幅两两比较 ,B >A、B >N(P <0 .0 1) ;③实验性治疗后MPQ和VAS有 8项参数值呈显著性或非常显著性降低 (P <0 .0 5— 0 .0 0 1) ,其余 3项及SEP中成分各参数无显著性差异 ;④陈旧性SCI的中枢性疼痛的自发痛与睡眠有一定关系。结论 :陈旧性胸腰段SCI的中枢性疼痛中的自发痛可能确与中枢兴奋性过高有一定关系 ,非特异性传导系统传入导致中枢觉醒水平提高可能为其主要原因之一。Objective:To approach the occurrence mechanism of spontaneous pain of long-term central pain in SCI.Method: Using MPQ , VAS and SEP of median nerve when spontaneous constant pain occurred (B), continuous numb pain happened (A) and there is no pain (N), to assess and observe the spontaneous pain in 12 cases suffering from long-term central pain in SCI. By a synthetical therapy, which mainly decrease the excitation of CNS patients were treated and assessed before and after the treatment.Result: ①Long term central pain in SCI was classified into 3 kinds and 2 types according its individual characters; ②NIPI wave was found in 80 to 100 ms of SEP. The amplitude comparison in the three groups was B>A ?B>N( P <0.01); ③Eight parameters in MPQ and VAS significantly or highly significantly decreased ( P <0.05-0.01 )after treatment; ④The pain had some relationship with sleeping.Conclusion: The spontaneous pain of long-term central pain in SCI might have a definite relation to excessively excitation of CNS , one of the main causes could be the increase of awareness level in CNS resulted from input of non-specificted trasmitting pathways.

关 键 词：脊髓损伤 中枢性疼痛 莫克吉尔疼痛答卷 体感诱发电位 综合治疗 SCI CP 

分 类 号：R651.2[医药卫生—外科学]