超声引导下选择性颈神经根阻滞治疗颈神经根痛:局部麻醉药联合神经妥乐平或糖皮质激素的随机对照研究  

Ultrasound-guided selective cervical nerve root block for cervical radicular pain: a randomized controlled trial of anesthetic in combination with neurotropin or glucocorticoids

作　　者：石潇 杨雨 方洪伟 王祥瑞 SHI Xiao;YANG Yu;FANG Hongwei;WANG Xiangrui(Department of Anesthesiology,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院麻醉科,上海200127 [2]同济大学附属东方医院麻醉与重症医学科

出　　处：《上海医学》2019年第8期463-466,共4页Shanghai Medical Journal

摘　　要：目的前瞻性研究局部麻醉药联合神经妥乐平或糖皮质激素用于超声引导下选择性颈神经根阻滞(SCNRB)治疗颈神经根痛的临床效果。方法2015年1月-2017年12月在上海交通大学医学院附属仁济医院疼痛科诊断为颈神经根痛的患者120例,随机分为糖皮质激素组和神经妥乐平组,每组60例,分别注射局部麻醉药(0.5%利多卡因1 mL)联合地塞米松(8 mg)或神经妥乐平(1 mL)进行超声引导下SCNRB治疗。治疗每2周重复1次,治疗后3、6、12个月时随访复查。主要监测指标为疼痛强度(疼痛VAS评分),次要监测指标包括疼痛残疾程度[颈部残疾指数(NDI)]和健康相关生活质量[SF-36健康状态量表身体相关评分(PCS)和精神相关评分(MCS)]。结果120例患者中17例因缺乏完整信息或在治疗前已接受SCNRB而被排除,最终103例纳入本研究,糖皮质激素组55例,神经妥乐平组48例。两组治疗前疼痛VAS评分、NDI、SF-36健康状态量表PCS和MCS的差异均无统计学意义(P值均>0.05)。治疗后3、6、12个月,两组的疼痛VAS评分和NDI均显著低于同组治疗前(P值均<0.05),SF-36健康状态量表PCS和MCS均显著高于同组治疗前(P值均<0.05),组间相同时间各指标的差异均无统计学意义(P值均>0.05)。两组均未发生严重不良反应。结论在超声引导下SCNRB中,联合使用局部麻醉药和神经妥乐平或糖皮质激素均可减轻颈部疼痛和降低NDI,改善健康相关生活质量,神经妥乐平与糖皮质激素具有相似的临床治疗效果。Objective To prospectively study the clinical effects of local anesthetics combined with neurotropin or glucocorticoids on cervical radicular pain in ultrasound-guided selective cervical nerve root block(SCNRB). Methods A total of 120 patients diagnosed with cervical radicular pain between January 2015 and December 2017 were randomly divided into glucocorticoid group and neurotropin group(n=60). Ultrasound-guided SCNRB was given by local anesthesia(0.5% lidocaine 1 mL) plus dexamethasone(8 mg) or neurotropin(1 mL). This treatment was repeated every two weeks, and follow-up was performed at 3, 6, and 12 months after treatment. The primary monitoring indicators were pain intensity(visual analog scale [VAS] score). Secondary monitoring indicators included pain disability(Neck Disability Index [NDI]) and health-related quality of life(SF-36 Health Status Scale: physical component summary [PCS], mental component summary [MCS]). ResultsSeventeen patients were excluded from this study because information was not complete or they had received SCNRB before treatment. Eventually, 55 in the glucocorticoid group and 48 in the neurotropin group were enrolled in this study. There were no significant differences in the pain VAS score, NDI, SF-36 health status scale PCS or MCS between the two groups before treatment(all P>0.05). At 3, 6 and 12 months after treatment, the VAS score and NDI of the two groups were significantly lower than those before treatment(all P<0.05), while PCS and MCS were significantly higher than those before treatment(all P<0.05). There was no significant difference in these indicators between the groups at each time(all P>0.05). No severe adverse events occurred in either group. Conclusion In the ultrasound-guided SCNRB, both neurotropin and glucocorticoids in combination with local anesthetics can alleviate neck pain, reduce NDI, improve health-related quality of life. Neurotropin and glucocorticoid have similar clinical therapeutic effects.

关 键 词：糖皮质激素类 颈神经根痛 神经妥乐平 超声引导 视觉模拟量表 颈部残疾指数 SF-36 

分 类 号：R[医药卫生]