臭氧复合PCEA用于脊柱相关手术后慢性疼痛的近期疗效分析

目的:观察和评价使用硬膜外PCA及臭氧-氧气介入治疗对于脊柱手术后慢性疼痛的治疗结果。方法:本组共28例患者,随机分为两组,每组14例。除了口服甲钴胺胶囊1mg,两次/日,鲁南贝特2片,两次/日,乐松60mg,两次/日外,A组使用持续硬膜外皮下隧道PCA技术(PCEA)治疗,B组使用PCEA 复合臭氧-氧气(30:70)介入治疗方法,使用处方为恩再适-0.1%罗哌卡因,硬膜外持续输注1.5～2.0ml/h,追加2ml/次,间隔时间为:15分钟。在使用PCEA5天后实施CT监护下臭氧-氧气介入治疗。观察指标包括VAS评分(静息痛、运动痛)、工作和生活能力、信心指数、睡眠和体能状态和HAMD评分。结果:本组共28例患者,绝大多数获得比较满意的临床效果,VAS评分(静息痛、运动痛)明显降低,A组由治疗前的6.88和8.41分降低至2.46和4.40分;B组降低至1.45和2.68分;HAMD评分由治疗前的21.33分降低至12.91和10.31分;信心指数由治疗前的4.23分增加至6.90和8.87分;少数患者出现背部穿刺点疼痛和腹部不适、下肢乏力感觉。结论:初步的观察表明PCEA或PCEA复合臭氧-氧气介入治疗用于脊柱相关手术后慢性疼痛能取得比较好的疗效,患者大部分体征得到有效控制后出院。长期效果有待于进一步的观察。

A CLINICAL INVESTIGATION OF PCEA AND OZONE INJECTION COMBINED PCEA ON PAIN OF PATIENTS WITH CHRONIC POST-SURGICAL PAIN

Objective: PCEA or ozone-oxygen injection used to relief the pain of patient with chronic post-surgical pain (CPSP). Methods:28 cases with CPSP were divided into two groups and 14 cases each. Oral NSAIDs was given in both groups. The methods of PCEA analgesin 3 ml and 0.1% ropivacaine, background flow 1.5~2.0 ml/h, bolus 2 ml in group A or ozone-oxygen(30:70) injection combined PCEA in group B were used to relieve pain, the index of VAS score, intensities of pain at rest or movement state, daily life ability, sleeping disorder or body energy and Hamilton score were also recorded. Results: The significant pain-relief,improved daily life ability, higher self-confident could be observed in both of groups. The average VAS scores were decreased from 6.88 ,8.41 at rest and movement to 2.46,4.40 in group A respectively and to 1.45,2.68 in group B respectively. Daily life ability scores were increased from 3.84 to 6.55,8.98 and self-confident scores were increased from 4.23 to 6.90,8.87 in group A and group B respectively. HAMD score decrease from 21.33 to 12.91 and 10.31. Conclusion: The most of pain patients with CPSP can be relieved by PCEA and ozone injection combined PCEA. The rapeutic effects in group A were better than that in group B. Long-time effect of ozone injection combined PECA should be investigated in the future.