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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

25卷

期数:

2019年01期

页码:

37-42

栏目:

临床医学

出版日期:

2019-01-20

文章信息/Info

Title:

The analgesic effect of intravenous methylprednisolone on acute neuropathic pain with allodynia due to central cord syndrome

文章编号:

1006-8147(2019)01-0037-06

作者:

李连栋¹; 雪 原¹; 周佳明¹; 孙 超²

（1.天津医科大学总医院骨科，天津 300052；2.天津医科大学代谢病医院骨科，天津 300070）

Author(s):

LI Lian-dong¹; XUE Yuan¹; Zhou Jia-ming¹; SUN Chao²

（1.Department of Orthopaedics Surgery，Tianjin Medical University，General Hospital，Tianjin 300052，China；2.Department of Orthopaedics Surgery，Tianjin Metabolic Diseases Hospital，Tianjin 300070，China)

关键词:

甲强龙; 中央型脊髓损伤; 神经痛; 痛觉超敏; 视觉模拟评分

Keywords:

methylprednisolone; central Cord Syndrome; neuropathic pain; allodynia; visual Analog Scale

分类号:

R744

DOI:

-

文献标志码:

A

摘要:

目的：回顾性分析静脉注射甲强龙（MP）治疗中央型脊髓损伤（CCS）急性神经痛的疗效和安全性。方法：选取天津医科大学总医院2016年7月-2017年11月患有急性神经痛、视觉模拟评分（VAS）≥6分的中央型脊髓损伤患者34例，所有患者均接受MP治疗1周，随访时间3个月。治疗前、治疗后和随访时均采用标准的VAS评分、痛觉超敏体表面积和生活质量调查问卷对治疗效果进行评估。结果：MP治疗后及治疗后3个月的随访，VAS评分、痛觉超敏体表面积和患者的生活质量均较治疗前明显改善（P<0.001），所有病例均未见疼痛复发。经MP治疗1周，自发性疼痛VAS评分（0.93±1.32）较治疗前（7.33±0.69）明显降低，第3月随访时，所有患者均实现显著性疼痛缓解（VAS≤2）；同时，痛觉超敏VAS评分较治疗前显著性下降（8.18±0.64 vs 1.70±1.43，P<0.001），第3月随访时，患者实现显著性疼痛缓解（VAS≤2）的比例达到91.18%；痛觉超敏的体表面积在治疗后及治疗后第1月和第3月随访分别为（101.65±205.55）cm2，（82.99±189.67）cm2及（36.77±106.29）cm2，与治疗前（2 791.23±625.20）cm2相比均显著性降低（P<0.001）。麦吉尔疼痛问卷表（MPQSF）和欧洲五维健康量表（EQ-5D）评估结果显示患者经MP治疗后生活质量获得明显改善（P<0.001），在MP治疗过程中，共有4例（11.76%）患者出现轻度的不良反应，以头晕和恶心居多，表现为一过性，在治疗后3个月随访中，所有病例未见MP相关性不良反应。结论：静脉注射MP能够有效缓解CCS急性神经痛，阻止急性神经痛转变为难治性慢性神经痛，能够显著改善患者的生活质量。

Abstract:

Objective: To retrospectively demonstrate the effects and safety of intravenous methylprednisolone (MP) on acute neuropathic pain relief，and the quality of life (QoL) in central cord syndrome (CCS) patients. Methods:From July 2016 to November 2017，34 CCS patients who suffered from severe acute neuropathic pain with allodynia were treated by intravenous MP for up to one week. The entire follow-up period was three months.Patients were evaluated with standard measures of efficacy: neuropathic pain intensity，the area of allodynia，and the QoL at baseline，daily treatment and one month and three months after the end of MP treatment. Results:After one week of MP treatment，the mean spontaneous pain intensity visual analog scale (VAS) scores ± SD before changed from 7.33±0.69 to 0.93±1.32 (P <0.001)，and the mean dynamic allodynia intensity VAS scores ± SD decreased significantly compared with the baseline (8.18±0.64 vs 1.70±1.43，P <0.001). At the end of the follow-up period (three months)，the proportions of patients who achieved excellent spontaneous pain and allodynia relief (VAS ≤2) were 100% and 91.18%，respectively.The allodynic areas decreased from（2 791.23±625.20）cm2 to（101.65±205.55）cm2 at endpoint of MP treatment and to（82.99±189.67）cm2 at the first month of follow-up and to（36.77±106.29）cm2 at the end of the follow-up period (all P <0.001). Moreover，this study showed MP could significantly improve the QoL of patients based on McGill Pain Questionnaire Short Form(MPQSF) and EuroQol Five Dimensions Questionnaire (EQ-5D). Four patients (11.76%) during MP treatment experienced mild or moderate side effects. None of the patients manifested CCS-associated neuropathic pain recurrence and MP-associated side effects during follow-up. Conclusion: Intravenous MP could provide effective pain relief and improvement in the QoL and prevent the transition from acute neuropathic pain into a chronic neuropathic pain in CCS patients with acute neuropathic pain.

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备注/Memo

备注/Memo:

基金项目 国家自然科学基金资助项目（81471403）
作者简介 李连栋（1990-），男，硕士在读，研究方向：颈胸椎、肩关节外科及成骨信号系统；通信作者：雪原，E-mail:xueyuanzyy@163.com。

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更新日期/Last Update: 2019-03-01