摘要
目的探讨采用脊髓电刺激(SCS)治疗神经病理性疼痛(NP)的测试效果及其影响因素。方法回顾性分析2012年1月至2019年12月首都医科大学宣武医院功能神经外科采用SCS治疗的81例NP患者的临床资料。对所有患者选择双极刺激模式,频率为30~60 Hz,脉宽为180~260μs,电压为0.5~2.0 V。以疼痛改善率作为SCS测试是否有效的主要评估指标,计算公式为:疼痛改善率=[术前视觉模拟评分(VAS)-术后VAS]/术前VAS×100%;其中疼痛改善率>50%为测试有效,≤50%为测试无效。采用单因素和多因素logistic回归分析法分析影响NP患者SCS测试效果的危险因素。结果81例患者均成功植入电极。81例患者术后疼痛改善率为(45.9±2.9)%;术后VAS为(4.5±2.5)分,较术前[(8.3±1.2)分]显著下降(t=13.67,P<0.01)。根据SCS测试有效的评估标准,45例患者为测试有效,36例为测试无效;测试有效率为55.6%(45/81)。单因素分析结果显示,年龄、性别、病程、术前VAS、病因、疼痛侧别及疼痛区感觉均不是SCS测试效果的影响因素(均P>0.05),而疼痛部位是SCS测试效果的影响因素(P<0.05)。进一步多因素logistic回归分析结果显示,疼痛位于下肢是影响SCS测试效果的保护因素(OR=3.14,95%CI:1.26~7.83,P=0.013)。结论采用SCS治疗NP的测试有效率较高;疼痛位于四肢,特别是下肢的NP患者测试效果较好。
Objective To investigate the therapeutic effect of spinal cord stimulation(SCS)screening trial on neuropathic pain(NP)and its influencing factors.Methods A retrospective analysis was conducted on the clinical data of 81 patients with NP who underwent SCS screening trial at Department of Functional Neurosurgery,Xuanwu Hospital of Capital Medical University from January 2012 to December 2019.Bipolar mode was employed in all patients with the frequency of 30-60 Hz,pulse width of 180-260μs,and voltage of 0.5-2.0 V.The rate of pain improvement was used as an indicator of whether the SCS screening trail was effective and calculated as[preoperative visual analogue scale(VAS)score-postoperative VAS score]/preoperative VAS score×100%.Univariate and multivariate logistic regression analyses were used to analyze the factors affecting the efficacy of SCS screening trail.Results A total of 81 patients were successfully implanted with SCS electrode.The overall postoperative pain relief rate was(45.9±2.9)%.Postoperative VAS score was 4.5±2.5,which was significantly lower than preoperative VAS score(8.3±1.2)(t=13.67,P<0.01).Based on the effectiveness criteria of SCS trial,45 patients were effective,36 patients were ineffective,and the effective rate in this series was 55.6%(45/81).Univariate analysis showed that age,gender,duration of illness,preoperative VAS score,etiology,side of pain or degree of hypoesthesia in the pain area was not the influencing factors of efficacy of SCS trial(all P>0.05),while the pain territory was the factor affecting the efficacy of SCS trial(P<0.05).Further multivariate analysis showed that lower limb pain was a positive factor for the efficacy of SCS test(OR=3.14,95%CI:1.26-7.83,P=0.013).Conclusions The overall effective rate of SCS trial in the treatment of NP seems relatively high.Patients with pain in the limb(s),particularly lower limb(s),may have a better trial outcome.
作者
倪兵
胡永生
张晓华
郭松
任志伟
舒伟
杜涛
卢光
朱宏伟
李勇杰
Ni Bing;Hu Yongsheng;Zhang Xiaohua;Guo Song;Ren Zhiwei;Shu Wei;Du Tao;Lu Guang;Zhu Hongwei;Li Yongjie(Department of Functional Neurosurgery,Xuanwu Hospital of Capital Medical University,Beijing Institute of Functional Neurosurgery,Beijing 100053,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2021年第1期26-30,共5页
Chinese Journal of Neurosurgery
关键词
神经痛
电刺激疗法
治疗结果
因素分析
统计学
Neuralgia
Electric stimulation therapy
Treatment outcome
Factor analysis,statistical
