普瑞巴林联合塞来昔布治疗腰椎间盘突出症经皮内镜术后神经病理性疼痛的疗效观察  

Effectiveness of combined Pregabalin and Celecoxib for treatment of neuropathic pain after percutaneous endoscopic lumbar discectomy

作　　者：李柱海 曾建成[1] 聂鸿飞[1] 蒋虎山 谢天航 宋跃明[1] 

机构地区：[1]四川大学华西医院骨科,成都610041 [2]广西壮族自治区人民医院骨科,南宁530021

出　　处：《中国修复重建外科杂志》2017年第2期215-221,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨普瑞巴林联合塞来昔布治疗腰椎间盘突出症经皮内镜术后神经病理性疼痛的疗效。方法2014年1月—6月采用经皮内镜椎板间入路腰椎间盘髓核摘除术治疗178例腰椎间盘突出症患者,其中90例符合选择标准纳入研究,并按照性别、病程、病变节段、吸烟史以及术前Leeds神经病理性症状和体征评分(LANSS)、Oswestry功能障碍指数(ODI)评分,等配比分成A、B、C组(n=30);试验期间9例患者因未完成研究或失访剔除研究。每组各27例纳入最终分析。3组患者性别、年龄、身高、体质量指数、病变节段、病程、吸烟史以及术前LANSS评分、ODI评分、疼痛视觉模拟评分(VAS)、手术时间等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。3组患者均从术前3 d至术后14 d口服塞来昔布;A组术前3 d开始加用普瑞巴林至术后14 d,B组术后14 d内加用普瑞巴林。服药期间观察患者药物不良反应发生情况。术前及术后1 d、1个月、3个月行静息及活动状态下VAS评分以及LANSS评分;术前及术后1、3个月行ODI评分;术后3个月记录发生神经病理性疼痛例数,采用改良Macnab标准评价临床疗效。结果试验期间,在增加普瑞巴林剂量时A组1例出现严重头晕,B组1例出现嗜睡,均停药并剔除研究;另有2例(A组1例、C组1例)出现口干,B组1例出现乏力,对症处理后症状缓解。术后1 d,A组LANSS评分、静息及活动状态下VAS评分均低于B、C组(P<0.05);术后1个月,A、B组LANSS评分、ODI评分、静息及活动状态下VAS评分均低于C组(P<0.05);术后3个月,A、B组LANSS评分、ODI评分及活动状态下VAS评分均低于C组(P<0.05);其余各时间点以上指标组间比较差异均无统计学意义(P>0.05)。术后3个月,7例患者发生神经病理性疼痛,其中A组1例(3.7%)、C组6例(22.2%),A、B组与C组比较差异有统计学意义(P<0.05),A、B组间比较差异无统计学意义(P>0.05)。按照改良Macnab评Objective To investigate the effectiveness of combined Pregabalin and Celecoxib for neuropathic pain after percutaneous endoscopic lumbar discectomy. Methods Between January and June 2014, 178 patients with lumbar disc herniation underwent percutaneous endoscopic interlaminar discectomy （PEID）. Ninety patients who met the inclusion criteria were recruited in this study. Every case in group A was recruited to match its counterpart in group B and group C according to gender, disease duration, herniated level, smoking history, preoperative Leeds assessment of neuropathic symptoms and signs （LANSS）, and Oswestry disability index （ODI）. Nine patients were excluded due to incomplete study or loss of follow-up. In each group, 27 cases were included in the final analysis. There was no significant difference in gender, age, height, body mass index, herniated level, disease duration, smoking history, preoperative LANSS, ODI, and visual analogue scale （VAS） between groups （P〉O.05）. All patients of 3 groups received oral administration of Celecoxib from preoperative 3rd day to postoperative 14th day. Pregabalin was taken orally from preoperative 3rd day to postoperative 14th day in group A, and from postoperative 1st to 14th day in group B. Adverse drug reactions were observed during medication. The LANSS score and VAS score in rest state and active state were conducted before operation and at 1 day, 1 month, and 3 months after operation. ODI was conducted before operation and at 1, 3 months after operation. The number of neuropathic pain cases was recorded, and the effectiveness was evaluated by modified Macnab criteria at 3 months after operation. Results During period of increasing Pregabalin dose, I patient of group A suffered severe dizziness, and 1 patient of group B suffered sleepiness, who were eliminated from this research. Another 2 cases （1 case of group A and 1 case of group C） suffered dry mouth, and 1 case of group B suffered muscle weakness. At 1 day after operation, the LANSS score a

关 键 词：腰椎间盘突出症 神经病理性疼痛 普瑞巴林 塞来昔布 

分 类 号：R687.3[医药卫生—骨科学]