疼痛定量测量仪Pain Vision在疼痛治疗中的应用

发布时间：2018-03-17 19:47

  本文选题：视觉模拟评分量表　切入点：电流感知阈值　出处：《山东大学》2017年博士论文　论文类型：学位论文

【摘要】：研究背景疼痛是临床中十分常见的症状,它不仅会让患者身体痛苦,还会影响患者心理状况,损害机体的各项机能,对机体造成不良的影响,可以说,疼痛已经成为危害人类健康的主要“杀手”之一,也是降低人们劳动能力,降低和减少出勤日最常见、最直接的因素之一。根据持续时间,疼痛可分为急性疼痛和慢性疼痛,其中慢性疼痛是疼痛诊疗的重要内容,其持续时间长,病因和发病过程复杂,临床表现多样化,严重影响患者的生活质量。在疼痛的诊断和治疗过程中,对于疼痛的评估一直困扰着临床工作者。传统的测量和评估疼痛的方法包括词语和数字的自我评定量表、行为观察量表和生理学方法等,其中视觉模拟评分量表(VAS)和简化的Mcgill疼痛问卷表(SF-Mcgill)是目前疼痛评估最常用的手段,正被广泛用于临床,另外,还有数字分级睡眠干扰评分法(NRSSIS)等,这些评估方式都有各自利弊,但这些传统的量表均是患者对自身疼痛的一种主观判断,个体差异较大,且不能将疼痛程度进行良好的量化测量。因此,我们需要一种客观、量化的疼痛评估方法。疼痛定量测量仪PainVision是一种末梢神经电刺激装置,可以准确、定时、反复刺激末梢神经,用于定量分析感觉和疼痛。目的本研究通过应用疼痛定量测量仪PainVision对慢性疼痛患者治疗前、症状明显好转时及出院时三个时间点的疼痛程度进行评估,并和传统的评价方法相比较,探讨疼痛定量测量仪PainVision在疼痛评估中应用的意义。同时,通过观察正常人感觉阈值的变化,对于不同年龄段的正常人在不同部位感觉阈值的测量,探讨了年龄和测量部位对感觉阈值的影响。方法研究分两部分进行:第一部分疼痛定量测量仪PainVsion在慢性疼痛治疗中的应用1.研究对象与分组:回顾性分析自2015年12月至2016年11月,在山东大学附属济南市中心医院疼痛科住院治疗的慢性疼痛患者106名,根据主要诊断分为以下5组:带状疱疹后神经痛组(PHN组,n=33)、癌性疼痛组(CP组,n=22)、腰椎间盘突出症组(PLID组,n=30)、复杂区域疼痛综合征组(CRPS组,n=11)、神经根型颈椎病组(CSR组,n=10)。2.测量指标:选择入院时(TO)、疼痛程度明显改善且VAS评分降至40mm以下时(T1)、出院时(T2)共3个时间点2.1 PHN组、CP组、PLID组、CRPS组和CSR组5组患者的持续性疼痛(PP):使用疼痛定量测定仪PainVision测量电流感知阈值(CPT)、疼痛等效电流(PEC),进而计算疼痛度(PD-PP)、疼痛率(PR-PP);采用VAS评分法、SF-Mcgill量表、NRSSIS评分法评估疼痛程度;比较疼痛定量测定仪PainVision测量结果和VAS评分法、SF-Mcgill量表、NRSSIS评分法的相关性。2. 2 PHN组和CP组2组患者爆发痛(BTP):使用疼痛定量测定仪PainVision测量电流感知阈值(CPT)、疼痛度(PD-BTP);采用VAS评分法、SF-Mcgill量表、NRSSIS评分法评估疼痛程度;比较疼痛定量测定仪PainVision测量结果和VAS评分法、SF-Mcgill量表、NRSSIS评分法的相关性。第二部分疼痛定量测量仪PainVision用于正常人感觉阈值测定的研究1.研究对象与分组:选择120名正常人,按照不同年龄段不同分为3组:Ⅰ组(18～40 岁,n=40); Ⅱ组:(41 ～60 岁,n=40); Ⅲ组:(61～80 岁,n=40)。2.测量指标:使用疼痛定量测量仪PainVision测量以下6个部位的CPT:左前臂(LMF)、右前臂(RMF)、左踝前(LFA)、左踝后(LBA)、右踝前(RFA)、右踝后(RBA)。结果第一部分疼痛定量测量仪PainVsion在慢性疼痛治疗中的应用1.1各组患者持续性疼痛PEC结果:与T0相比,PHN组、CP组、PLID组、CSR组4组在T1、T2时间点时,PEC值均降低,差异具有统计学意义(P0. 05);CRPS组PEC值T1时变化不明显(P0.05),但T2时降低,差异具有统计学意义(P0.05)。与T1相比,CP组、PLID组和CSR组3组患者的PEC值在T2时降低,差异具有统计学意义(P0.05)。1.2各组患者PR-PP结果:与T0相比,PHN组、CP组、PLID组、CRPS组和CSR组5组T1、T2时间点PR-PP值均降低,差异具有统计学意义(P0.05)。与各组T1时间点相比较,CP组、CRPS组和CSR组3组PR-PP值在T2时降低,差异具有统计学意义,(P0.05)。1.3各组患者PD-PP结果:与T0相比,PHN组、CP组、PLID组、CSR组4组在T1和T2时间点PD-PP值均降低,差异具有统计学意义(P0.05); CRPS组在T2时降低,差异具有统计学意义(P0. 05)。与T1相比较,CP组、CRPS组、PLID组和CSR组4组患者T2时PD-PP值减少,差异具有统计学意义(P0.05)。1. 4 PHN组和CP组患者PD-BTP结果:与TO相比,PHN组和CP组PD-BTP值在T1和T2时均降低,差异具有统计学意义(P0.05)。与T1相比较,PHN组和CP组两组患者在T2时的PD-BTP的值降低,差异具有统计学意义(P0. 05)。1.5疼痛度(PD)与VAS、SF-Mcgill和NRSSIS相关性比较与VAS评分相比,PHN组、PLID组、CRPS组和CSR组的持续性疼痛的疼痛度(PD-PP)与之存在相关(P0. 05),而CP组与之无相关性;PHN组和CP组的爆发痛的疼痛度(PD-BTP)与之存在相关性(P0.05)。与SF-Mcgill评分和NRSSIS评分相比,PHN组、CP组、PLID组、CRPS组和CSR组5组的PD-PP、PHN组和CP组的PD-BTP与之均不存在相关性(P0. 05)。第二部分疼痛定量测量仪PainVision用于正常人感觉阈值测定的研究1.CPT值组内比较:Ⅰ组、Ⅱ组、Ⅲ组组内比较,LMF和RMF均无明显差异(P0.05);与LMF相比,LFA、LBA、RFA、RBA四个部位的CPT值明显增高,差异具有统计学意义(P0. 05)。2. CPT值组间比较:与Ⅰ组相比,Ⅱ组和Ⅲ组的六个部位的CPT值均明显增高,差异具有统计学意义(P0.05)。与Ⅱ组相比,Ⅲ组CPT值明显增高,差异具有统计学意义(P0.05)。结论1.疼痛定量测量仪PainVision能够量化评价持续性疼痛和爆发痛,疼痛度能够以量化的形式表达。2.疼痛定量测量仪PainVision测量出的慢性疼痛的持续性疼痛和爆发痛的疼痛度和视觉模拟评分量表具有正相关关系。3.疼痛定量测量仪PainVision能够定量评价感觉阈值。4.不同年龄和不同测量部位,CPT的结果不同:随着年龄的增长CPT逐渐增加,下肢CPT明显高于上肢。前臂中点偏尺侧是本研究中CPT测量中最敏感部位。
[Abstract]:Background pain is very common in clinical symptoms, it will not only help patients with physical pain, but also affect the psychological status of the patients, damage the function of the body, causing adverse effects on the body, it can be said that the pain has become a major hazard "killer" of human health is one of the people, reduce the labor ability, and reduce attendance on one of the most common, the most direct factor. According to the duration of pain can be divided into acute and chronic pain, chronic pain, which is an important part of diagnosis and treatment of pain, which lasted for a long time, the etiology and disease process is complex and diverse clinical manifestations, seriously affecting the quality of life of patients. In the diagnosis and treatment of pain and for the assessment of pain has been plagued by clinical workers. Methods of measurement and evaluation of the traditional pain include self rating scale of words and numbers, behavior observation scale and students Science methods, including visual analogue scale (VAS) and simplified Mcgill pain questionnaire (SF-Mcgill) is currently the most commonly used means of pain assessment, has been widely used in clinical, in addition, there are digital classification of sleep disturbance score method (NRSSIS), the evaluation method has its own advantages and disadvantages, but these the traditional scale is a kind of subjective judgment of the patients to their own pain, individual differences, and not pain quantitative measurement well. Therefore, we need an objective, quantitative pain assessment methods. The pain quantitative measurement instrument PainVision is a peripheral nerve stimulation device can accurately and timing. Repeated stimulation of nerve endings, for quantitative analysis of sensory and pain. The purpose of this study is through the application of quantitative measurement of PainVision in the treatment of pain in patients with chronic pain before, when the symptoms were improved and discharged at three time points. To assess the degree of pain, and compared with traditional evaluation methods, application of quantitative measuring instrument PainVision pain in pain assessment significance. At the same time, by observing the changes of normal human sensory threshold, for different age groups of normal people in different parts of the sensory threshold measurement, discusses the influence of age and measurement sites on the feeling the threshold method. The study is divided into two parts: the first part of the pain quantitative measurement instrument using PainVsion in treatment of chronic pain in 1. subjects and groups: retrospective analysis from December 2015 to November 2016, in patients with chronic pain pain, Ji'nan Central Hospital Affiliated to Shandong University hospital in 106, according to the diagnosis is mainly divided into the following 5 groups: postherpetic neuralgia group (group PHN, n=33), cancer pain group (group CP, n=22), lumbar disc herniation group (PLID group, n=30), complex regional pain syndrome group (CRP S缁，

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