脑卒中后中枢性疼痛患者的临床特征分析  

Clinical features of central post-stroke pain

作　　者：张晓玲[1] 翟丽萍[1] 官俏兵[1] 钱淑霞[1] 陈思超[2] 陈中栋[1] 朱敏初[1] 徐从英[1] 余波[1] 王琰萍[1] 

机构地区：[1]浙江省嘉兴学院附属第二医院神经内科,314000 [2]浙江省余姚市人民医院神经内科,315400

出　　处：《中华全科医师杂志》2016年第6期439-443,共5页Chinese Journal of General Practitioners

基　　金：基金项目：浙江省医药卫生一般研究计划（2013KYB260）;浙江省医学会临床科研基金（2012ZYC-A64）

摘　　要：目的 了解脑卒中后中枢性疼痛（CPSP）的发生率以及临床特征.方法 回顾性分析2013年7月至2014年6月在我院神经内科住院或卒中门诊就诊、发生脑卒中后≥1个月的1 130例患者的临床资料.其中出血性脑卒中患者289例、缺血性脑卒中841例,根据卒中后疼痛情况,分为CPSP组80例、非CPSP伴疼痛组467例和无疼痛组583例.3组患者的年龄、病程、卒中类型、合并疾病情况比较,差异均无统计学意义（均P＜0.05）.采用抑郁自评量表（SDS）评价抑郁、采用焦虑自评量表（SAS）评价焦虑情况;对547例伴有卒中后疼痛患者行疼痛视觉模拟评分（VAS）、疼痛画图、感觉检查及简易疼痛量表（BPI）评估疼痛对生命质量的影响.结果 共547例（48.4％）有卒中后疼痛,其中80例（7.1％） CPSP者.3组患者在病灶大小（P =0.308、0.056、0.340）及脑区分布（P=0.915、0.857、0.999）比较差异无统计学意义,但CPSP组在卒中病灶偏侧分布上以右侧为多66.2％（53/80）,与其他二组比较,差异有统计学意义（χ^2=13.86、25.97,均P=0.001）;CPSP组患者的感觉检查均有异常;CPSP组和非CPSP伴疼痛组的VAS评分[（60.4±6.8）与（58.7±5.8）分）]、BPI评分[（5.4±1.8）与（5.2±1.6）分]、SAS评分[（56.7±4.3）与（52.8±3.9）分]和SDS评分[（54.9±4.1）与（55.1±4.4）分]比较,差异均无统计学意义（t值分别为0.851、0.350、0.674和0.335,P值分别为0.397、0.727、0.503和0.742）;CPSP组SAS评分、SDS评分高于无疼痛组[（32.1±2.8）和（37.6±3.1）分,t值分别为68.383和33.654,均P=0.000],mRS≤2分率（36.3％,29/80）低于无疼痛组（61.6％,359/583）,差异有统计学意义（χ^2=12.503,P=0.000）;CPSP组接受联合止痛治疗率（32.5％,26/80）高于非CPSP伴疼痛组（14.6％,68/467）,差异有统计学意义（χ^2=8.651,P=0.001）.结论 CPSP不罕见,影响卒中预后,临床上加以评估并有效干预十分必要.Objective To analyze the clinical features of central post-stroke pain （CPSP）.Methods A total of 1 130 patients including 289 cases of hemorrhagic stroke and 841 cases of ischemic stroke,who visited the neurology department one month after stroke during July 2013 to June 2014,were enrolled in the study.The patients were divided into 3 groups：CPSP group （n =80）,non-CPSP pain group （n =467） and no-pain group （n =583）.The general conditions and clinical features of patients were documented;depression and anxiety was evaluated with Self-rating Depression Scale （SDS） and Self-rating Anxiety Scale （SAS）;the severity of pain was assessed with Visual Analogue Scale （VAS）,pain drawing,sensory tests and brief pain inventory （BPI）.Results There were no statistically significant differences in age,course of disease,types of stroke,size of lesions,lesion distribution in cerebral regions and coexistent diseases among three groups.Compared with non-CPSP pain group and no-pain group,CPSP group had higher proportion of lesions in right side [66.2% （53/80） vs.40.5% （189/467）,66.2% （53/80） vs.38.9% （227/583）,χ^2 =13.86,25.97,both P =0.001].Sensory tests in CPSP group were all abnormal.No significant differences were found in scores of VAS （60.4 ± 6.8 vs.58.7 ± 5.8）,BPI （5.4 ± 1.8 vs.5.2 ± 1.6）,SAS（56.7 ±4.3 vs.52.8 ±3.9） and SDS （54.9 ±4.1 vs.55.1 ±4.4） between CPSP group and non-CPSP pain group （t =0.851,0.350,0.674,0.335,P =0.397,0.727,0.503,0.742）.But compared with no-pain group,patients in CPSP group had higher scores of SAS and SDS （t =68.38,33.65,both P =0.000）.Ratio of mRS≤2 in CPSP group [36.6% （29/80）] was lower than that of no pain group [61.6% （359/583）,χ^2 =12.503,P =0.000].Patients in CPSP group received more combined analgesic therapy than non-CPSP pain group [32.5% （26/80） vs.14.6% （68/467）,χ^2 =8.651,P =0.001].Conclusion CPSP may affect the prognosis of patients with stroke,clinical evaluation and effective interve

关 键 词：卒中 神经痛 中枢性 病理状态 体征和症状 问卷调查 

分 类 号：R743.3[医药卫生—神经病学与精神病学]