下腰椎旁外向盲穿骶丛神经根阻滞用于慢性下肢疼痛治疗的安全性和有效性研究  

The safety and efficacy of lower lumbar paravertebral outward blind puncture blocking sacral plexus nerve root for treatment of lower limb pain

作　　者：李丽芝 袁建蓉 彭红艳 陈金梅 王海慧 崔剑 刘蓓 聂发传 Li Lizhi;Yuan Jianrong;Peng Hongyan;Chen Jinmei;Wang Haihui;Cui Jian;Liu Bei;Nie Fachuan(Department of Painology,The Third Affiliated Hospital of Chongqing Medical University,Chongqing City 401120,China;Department of Painology,The First Affiliated Hospital of Army Medical University,Chongqing City 400038,China;Department of Anesthesiology,Guizhou International General Hospital,Guiyang City,Guizhou Province 472199,China)

机构地区：[1]重庆医科大学附属第三医院疼痛科,重庆市401120 [2]陆军军医大学第一附属医院疼痛科,重庆市400038 [3]贵黔国际总医院麻醉科,贵阳市472199

出　　处：《中华疼痛学杂志》2024年第6期891-897,共7页Chinese Journal Of Painology

摘　　要：目的探讨下腰椎旁外向盲穿骶丛神经根阻滞用于疼痛治疗的安全性和有效性。方法本研究采用大样本回顾性研究结合小样本前瞻性随机对照临床试验的方法。收集重庆医科大学附属第三医院疼痛科门诊2023年5月1日至2024年1月31日按就诊时间顺序行骶丛神经根阻滞的慢性疼痛患者44例,采用随机数字表法分为高浓度局麻药组(HCA组)和低浓度局麻药组(LCA组),每组22例。HCA组患者采用高浓度神经阻滞液(100 mg/10 ml的盐酸罗哌卡因5 ml+复方倍他米松1 ml+维生素B_(12)1 ml+生理盐水至10 ml)下腰椎旁外向盲穿骶丛神经根阻滞治疗;LCA组患者采用低浓度神经组织液(100 mg/10 ml的盐酸罗哌卡因3.3 ml+复方倍他米松1 ml+维生素B_(12)1 ml+生理盐水至10 ml)行相同方法治疗。记录比较患者治疗前及治疗后30 min、24 h下肢体表温度和触觉、肌力、原有下肢疼痛评分及各种不良反应。同时回顾总结2003年1月至2023年6月按照本研究治疗方案(操作者自由选择HCA/LCA组方案之一)实施的本神经阻滞方法长期探索性临床治疗的7000例次患者的印象性数据特征,并进行数据分析。结果两组患者阻滞治疗后患侧下肢均迅速发生了不同程度的体表温度升高、触觉下降和疼痛缓解,15%~25%患者出现了患侧下肢肌力轻微降低,HCA组患者程度稍重,但影响行走的人数占比极少。20年间经历过治疗的7000例次患者相关日常记录资料及操作者印象回访显示了相似的趋势。结论下腰椎旁外向盲穿骶丛神经根阻滞疗法安全、有效,操作简便快速。ObjectiveTo investigate the safety and efficacy of lower lumbar paravertebral outward blind puncture blocking sacral plexus nerve root for treatment of lower limb pain.MethodsA large sample retrospective study combined with a small sample prospective randomized controlled clinical trial was performed in this study.Between May 2023 and January 2024,44 patients with chronic pain in the Outpatient Department of Painology,the Third Affiliated Hospital of Chongqing Medical University,suitable for sacral plexus root block were selected.The patients were randomly divided into two groups using a random number table method:group HCA(1/2 concentration of local anesthetic solution),group LCA(1/3 concentration of local anesthetic solution).The limb surface temperature,tactile sensation,muscle strength,pre-existing lower limb pain scores,and various adverse reactions were recorded before the treatment and 30 min,24 h after the treatment.The impressionistic characteristics of 7000 patients who underwent long-term exploratory clinical treatment with this block method were reviewed and analyzed from January 2003 to June 2023.ResultsAfter the block,the lower limbs surface temperature rapidly increased,tactile sensation decreased,and pain alleviated in all patients of both groups.A slight decrease of muscle strength in the affected lower limbs happened in 15%-25%of patients,without walking problem,and group HCA had a slightly heavier than that in group LCA.The retrospective analysis of the 7000 patients showed a similar trend.ConclusionThe lower lumbar paravertebral outward blind puncture blocking sacral plexus nerve root is a safe and effective method for patients with chronic pain in lower limb.

关 键 词：骶丛神经 神经根 椎旁阻滞 盲穿 外向穿刺 有效性 安全性 门诊 疼痛治疗 

分 类 号：R47[医药卫生—护理学]