摘要
目的探究周围神经阻滞对卒中后中枢性疼痛(CPSP)患者的临床疗效以及初级感觉传入在卒中后中枢性疼痛中的作用。方法本研究选取了2022年3—12月在重庆医科大学附属永川医院康复科住院的22例CPSP患者为研究对象。将22例患者随机分成2组,一组接受利多卡因阻滞治疗,另一组接受安慰剂对照治疗,每组11例患者。均予以疼痛部位超声引导下的周围神经阻滞治疗,利多卡因阻滞组患者注射含有1∶200000肾上腺素的2%利多卡因,安慰剂对照组患者则注射等量生理盐水。治疗前后对2组患者进行疼痛数字评分法(NRS)评分、诱发反应评分,以及利多卡因血药浓度测试。结果所有患者在大脑病变半球对侧的疼痛区域均出现机械和/或温度敏感反应。利多卡因阻滞组的自发性疼痛缓解程度为(-82.8±16.3)%,优于安慰剂对照组的(-1.8±21.3)%,差异有统计学意义(P<0.05)。利多卡因阻滞组患者在治疗后7 min时,自发性疼痛基本得到明显缓解;在治疗后1 h开始出现NRS评分上升趋势;4名患者在治疗后8 h的NRS评分仍处于较低水平。安慰剂对照组患者在治疗后2 min时,大多患者出现NRS评分轻微升高,随后逐渐恢复到治疗前疼痛评分。T_(30)时,利多卡因阻滞组患者疼痛部位的诱发反应评分低于安慰剂对照组,差异有统计学意义(P<0.05)。T_(30)时,利多卡因阻滞组患者疼痛部位对医用棉签、单丝针刺、冷刺激、热刺激的诱发反应评分均低于T0,差异有统计学意义(P<0.05),而安慰剂对照组疼痛部位对医用棉签、单丝针刺、冷刺激、热刺激的诱发反应评分与T0时相比,差异无统计学意义(P>0.05)。结论周围神经阻滞对CPSP具有一定的缓解作用,安全有效。初级感觉传入在CPSP患者的疼痛维持中具有重要作用,这可能为CPSP的靶向治疗开辟新视野。
Objective This study aimed to explore the clinical efficacy of peripheral nerve blockade in patients with central post-stroke pain(CPSP)and the role of primary sensory input in CPSP.Methods This study included 22 CPSP patients admitted to the Department of Rehabilitation Medicine at the Affiliated Yongchuan Hospital of Chongqing Medical University between March and December 2022.They were randomly allocated to receive lidocaine blockade treatment or placebo control treatment,with 11 patients in each group.Both groups underwent peripheral nerve blockade under ultrasound guidance at the site of pain.The lidocaine blockade group received an injection of 2%lidocaine containing 1∶200000 epinephrine,while the placebo control group received an injection of the samt amount of saline.Pain Numeric Rating Scale(NRS)scores,evoked response scores,and lidocaine blood concentration were evaluated before and after treatment in both groups.Results All patients experienced mechanical and/or temperature sensitivity in the pain area contralateral to the cerebral lesion.The degree of spontaneous pain relief in the lidocaine blockade group was significantly superior to that in the placebo control group[(-82.8±16.3)%vs.(-1.8±21.3)%;P<0.05].In the lidocaine blockade group,spontaneous pain was significantly relieved after 7 minutes of treatment,and an upward trend in NRS scores was observed after 1 hour of treatment.Four patients in the lidocaine blockade group still had low NRS scores at 8 hours after treatment.In the placebo control group,most patients had a slight increase in NRS scores at 2 minutes after treatment,which gradually returned to the pretreatment pain scores.At T_(30),the evoked response scores in the pain area of the lidocaine blockade group were significantly lower than those in the placebo control group(P<0.05).At T_(30),the evoked response scores in the lidocaine blockade group for cotton swabs,monofilament needle puncture,cold stimulation,and heat stimulation were significantly lower than those at T0(P<0.05).However,no statistically significant difference was found in the evoked response scores in the pain area of the placebo control group for cotton swabs,monofilament needle puncture,cold stimulation,and heat stimulation compared to T0(P>0.05).Conclusion Peripheral nerve blockade demonstrates alleviating effects on CPSP,with a high safety profile.Primary sensory input plays an important role in the maintenance of pain in CPSP patients,which may open up new perspectives for targeted treatment of CPSP.
作者
王秀静
李灵聪
王振宇
Wang Xiujing;Li Lingcong;Wang Zhenyu(Department of Rehabilitation Medicine,The Affiliated Yongchuan Hospital of Chongqing Medical University,Chongqing 402160,China)
出处
《保健医学研究与实践》
2023年第12期43-50,共8页
Health Medicine Research and Practice
基金
国家自然科学基金资助项目(81674066)。
作者简介
第一作者:王秀静,E-mail:wangxiujing1103@163.com;通信作者:王振宇,E-mail:wangzhenyudr@163.com。
