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

发布时间：2019-03-01 18:32

【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(P0.05),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(P0.05);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(P0.05);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(P0.05);其余各时间点以上指标组间比较差异均无统计学意义(P0.05)。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(P0.05),A、B组间比较差异无统计学意义(P0.05)。按照改良Macnab评价标准,A、B、C组优良率分别为92.6%、88.9%、85.2%,3组间比较差异无统计学意义(P0.05)。结论腰椎间盘突出症经皮内镜术围手术期口服普瑞巴林联合塞来昔布能减轻患者术后疼痛程度,降低神经病理性疼痛发生率。术前口服普瑞巴林能减少术后急性神经病理性疼痛的发生。
[Abstract]:Objective to investigate the therapeutic effect of prapamil combined with celecoxib in the treatment of neuropathic pain after percutaneous endoscopic lumbar disc herniation (LIDP). Methods from January to June, 2014, 178 patients with lumbar disc herniation were treated by percutaneous endoscopic interlaminar discectomy, 90 of which were included in the study according to sex, course of disease and segment of lesion, and 90 of them were included in the study according to sex, course of disease and pathological segment. Smoking history and preoperative Leeds neuropathic symptoms and signs score (LANSS), Oswestry dysfunction index (ODI) score, equal score was A, B, C group (n = 30); During the trial, 9 patients were excluded because of incomplete study or missed follow-up. Gender, age, height, body mass index, lesion segment, course of disease, smoking history and preoperative LANSS score, ODI score and pain visual analogue score (VAS),) were included in the final analysis of 27 cases in each group. There was no significant difference in operation time and other general data (P0.05). Three groups of patients were taken celecoxib orally from 3 days before operation to 14 days after operation, and all the three groups were treated with celecoxib orally from 3 days before operation to 14 days after operation. The patients in group A received prednisine from 3 days before operation to 14 days after operation, and those in group B received prednisone within 14 days after operation. The incidence of adverse drug reactions was observed during the medication period. Before and 1 day, 1 month and 3 months after operation, VAS score and LANSS score were performed at rest and activity, ODI score was performed before operation and 1 month and 3 months after operation. Cases of neuropathic pain were recorded 3 months after operation, and the clinical efficacy was evaluated by modified Macnab criteria. Results during the experiment, one case in group A developed severe dizziness and one case in group B developed somnolence when the dosage of primadipine was increased. All patients were stopped and removed from the study. The other 2 cases (1 case in group A and 1 case in group C) developed dry mouth and 1 case in group B showed fatigue. The symptoms were relieved after treatment. On the 1st day after operation, the LANSS score, VAS score at rest and activity in group A were lower than those in group B, group C (P0.05), and the scores of LANSS, ODI, VAS at rest and activity in group A and B were lower than those in group C at the first month after operation (P0.05). At 3 months after operation, the LANSS score, ODI score and VAS score in group A and B were lower than those in group C (P0.05), but there was no significant difference in the other indexes above each time point (P0.05). Three months after operation, 7 patients developed neuropathic pain, including 1 case in group A (3.7%), C), 6 cases (22.2%) in group A, and there was significant difference between group A and group C (P0.05), A,). There was no significant difference between groups B (P0.05). According to the improved Macnab criteria, the excellent and good rates of A, B and C groups were 92.6%, 88.9% and 85.2%, respectively. There was no significant difference among the three groups (P0.05). Conclusion Peri-operative oral prednisone combined with celecoxib can relieve postoperative pain and reduce the incidence of neuropathic pain in patients with lumbar disc herniation. Oral prednisone before operation can reduce the incidence of postoperative acute neuropathic pain.
【作者单位】：四川大学华西医院骨科;广西壮族自治区人民医院骨科;
【分类号】：R687.3

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