不同剂量糖皮质激素硬膜外注射治疗椎间盘源性根性痛  

Epidural injection of different doses of glucocorticoid in the treatment of discogenic radicular pain

作　　者：郝冲 章阳 程祝强 曾永芬 刘红军 金毅 HAO Chong;ZHANG Yang;CHENG Zhuqiang;ZENG Yongfen;LIU Hongjun;JIN Yi(School of Anesthesiology,Xuzhou Medical University,Xuzhou 221004,China;Department of Painology,General Hospital of Eastern Theater Command,Nanjing 210002,China)

机构地区：[1]徐州医科大学麻醉学院,徐州221004 [2]中国人民解放军东部战区总医院疼痛科,南京210002

出　　处：《中国疼痛医学杂志》2023年第3期186-193,共8页Chinese Journal of Pain Medicine

基　　金：江苏省重点研发项目(BE2018669)。

摘　　要：目的:观察不同剂量甲泼尼龙硬膜外注射(epidural injections,EI)治疗腰椎间盘源性根性痛的有效性和安全性,探讨甲泼尼龙EI治疗的合适剂量。方法:本研究为一项前瞻性、观察性试验,选取东部战区总医院2022年1月至2022年7月因腰椎间盘突出导致根性疼痛于疼痛科就诊的病人93例,根据甲泼尼龙硬膜外注射使用剂量分为A组(10 mg)32例、B组(20 mg)32例和C组(40 mg)29例,比较三组术前、术后1、2、3天和7天疼痛数字评分法(numerical rating scale,NRS)评分,术前、术后1天空腹血糖、血清促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)和血清皮质醇水平的差值,并分析影响疼痛有效缓解的相关因素。结果:与术前相比,各组病人术后各时间点NRS评分均明显降低(P<0.001),术后7天B、C两组病人NRS评分明显低于A组(P<0.01)。术前NRS评分和糖皮质激素剂量为影响术后7天疼痛有效缓解的独立危险因素。术前与术后1天空腹血糖、血清皮质醇、ACTH水平差值三组间存在差异,且C组>B组>A组。三组不良反应发生率无明显差异。结论:20 mg甲泼尼龙EI治疗椎间盘源性根性痛与40 mg疗效相当,优于10 mg;三组不良反应发生率无差异。且更小的剂量能降低甲泼尼龙对相关激素及血糖的影响;术后7天时术前中度疼痛病人较重度疼痛者疗效更好。Objective:To observe the efficacy and safety of different doses of methylprednisolone epidural injection(EI)in the treatment of lumbar intervertebral disc radicular pain,and to explore the appropriate EI dose of methylprednisolone.Methods:This study is a prospective and observational trial.Ninety-three patients with radicular pain caused by lumbar disc herniation from January 2022 to July 2022 were enrolled and divided into group A(10 mg)32 patients,group B(20 mg)32 patients and group C(40 mg)29 patients according to the dosage of EI with methylprednisolone.The numerical rating scale(NRS)score of the three groups were compared before operation,1,2,3 and 7 days after operation.The differences of fasting blood glucose,serum concentration in adrenocorticotropic hormone(ACTH)and serum cortisol concentration before and 1 day after operation were analyzed.Furthermore,the related factors affecting effective pain relief were also analyzed.Results:Compared with before operation point,the NRS scores of each group decreased significantly at each time point after operation(P<0.001).On the day 7 after operation,the NRS scores of group B and C were significantly lower than that of group A(P<0.01).Preoperative NRS scores and glucocorticoid dose were independent risk factors for effective pain relief 7 days after operation.The differences in fasting blood glucose,serum cortisol and ACTH concentration among the three groups before operation and 1 day after operation wer significantly different,and group C>group B>group A.There was no significant difference in the incidence of adverse reactions among the three groups.Conclusion:EI with the dose of 20 mg methylprednisolone has the same efficacy as 40 mg in the treatment of radicular pain associated with lumbar disc herniation,superior to 10 mg.There was no difference in the incidence of adverse reactions among the three groups.Additionally,lower dosage can reduce the effect of methylprednisolone on related hormones and blood glucose.At 7 days after oper-ation,the curative effect of

关 键 词：腰椎间盘突出症 根性疼痛 硬膜外注射 糖皮质激素 

分 类 号：R687.3[医药卫生—骨科学]