摘要
目的:观察神经阻滞方法治疗髂腹下神经痛患者的镇痛效果与情绪变化的相关性。方法:纳入中国医科大学附属第二医院疼痛门诊2000-04/2004-12收治的髂腹下神经痛患者40例,均有不定期出现下腹部脐耻间持续性、针刺样或刀挑样或抽痛样疼痛,反复发作,≥3个月。采用敏化疼痛点阻滞或髂腹下神经阻滞方法阻滞交感神经,①有27例采用了敏化疼痛点阻滞术治疗,施术前先作痛点标记,进针到深筋膜,注入质量浓度为0.02g/L利多卡因注射液1mL,再挺进针尖穿过深筋膜,注质量浓度为0.02g/L利多卡因注射液2mL。②另13例采用了髂腹下神经阻滞治疗,在髂前上棘与脐连线上,自髂前上棘内上方约2.5cm处,进针穿过腹外斜肌腱膜和腹内斜肌腱膜,在腹内斜肌和腹横肌之间,用质量浓度为0.01g/L的利多卡因注射液10mL,按退针-抽吸-注药,再退针-再抽吸-再注药之顺序形成扇形分布直至针尖完全退出。3次/周为1个疗程,治疗前和治疗后第1,2疗程使用简式McGill疼痛问卷(由3部分组成,①疼痛分级指数的评定,总分越高说明疼痛越严重。②目测类比评分,0为无痛,100为剧痛。③现有疼痛强度评定分级,根据患者主观标记相应分值。3部分总分为McGill疼痛评分对患者进行疼痛评价。同时使用汉密顿抑郁量表(共17个部分,18个问题。最低得分为0分,最高得分为52分。得分越高病情越严重,20分以上者为抑郁状态,经过治疗后降到7分以下为效果满意,正常人为2.0～5.5分)对治疗前后患者情绪进行分析。结果:按实际处理分析,40例均进入结果分析。①治疗前后简式McGill疼痛评分比较:治疗后第1,2疗程低于治疗前犤(53.2±5.7),(26.4±7.9),(86.5±8.3)分,P<0.05犦。②汉密顿抑郁量表治疗前后评分比较:治疗后第1,2疗程低于治疗前犤(7.6±2.1),(4.3±1.4),(23.2±6.3)分,P<0.05犦。结论:神经阻滞治疗髂腹下神经痛可改善患者疼痛状况,疼痛的减轻使患者的抑郁状态和不良情绪得以改善。神经阻滞治疗髂腹下神经痛在发挥镇痛作用的同时又具有改善抑郁情绪的功效。
AIM： To observe the correlation between the analgesic effect and emotional changes in patients suffering from iliohypogastric neuralgia treated by means of nerve block. METHODS： Forty outpatients with iliohypogastric neuralgia in the clinical of pain management, the Second Affiliated Hospital of China Medical Unviersity between April and December 2000 participated in the study. They all suffered from repeated, continuous, pinprick-like or knives pick- ing pain or tic pain at uncertain period in the lower abdomen between navel and pubis for at least 3 months. Their sympathetic nerves were blocked by means of blocking the sensitive pain point or blocking iliohypogastric nerve. ① Twenty-seven cases were treated by blocking the sensitive pain point： The pain point was marked before treatment, and then the needle was inserted into the deep fascia and 1 mL lidocaine （0.02 g/L） was infused, and then the needle was advanced through the deep fascia, 2 mL lidocaine （0.02 g/L） was infused. ② The other 13 cases were treated by blocking iliohypogastric nerve. The needle was inserted through obliquus externus abdominis fascia and obliquus internus abdominis fascia on the line between anterior superior iliac spine and navel, and 2.5 cm away from the upper side of anterior superior iliac spine, and then 10 mL lidocaine （0.02 g/L） was infused between obliquus internus abdominis and transverses abdominis. The needle was given with a sectoral distribution according to the order of needle withdrawal- suction-infusion and needle re-withdrawal-resuction-reinfusion until the needle point exited completely. The patients were treated 3 times a week as a course. Before treatment and after treated for 1 and 2 courses, the paint of the patients was evaluated with the simple MaGill pain questionnaire, which consisted of 3 parts： ① evaluation of pain grading index, the higher the score, the severer the pain; ② eye-measured analogy score： 0 as painless and 100 as baryodynia; ③ present painful intensity grading： the scores were marked according to the feeling of the patients; （the total score of the 3 parts was taken as the score of McGill pain）. Before and after treatment, the emotion of the patients was analyzed with Hamilton depression scale （consisted of 17 parts, including 18 questionnaires, the lowest and highest scores were 0 and 52 points respectively; the higher the score, the severe their disease; more than 20 points was taken as de- pression, the score decreased to less than 7 points after treatment as satisfaetory effect, 2.0 to 5.5 points as normal）. RESULTS： According to actual analysis, all the 40 cases were involved in the analysis of results. ① Before and after treatment, comparison of simple McGill pain questionnaire： It was lower at 1 and 2 courses after treatment fhan before treatment [（53.2±5.7）, （26.4±7.9）, （86.5±8.3） points, P 〈 0.05]. ② Comparison of Hamilton depression scale before and after treatment： It was lower at 1 and 2 courses after treatment than before treatment [ （7.6±2.1）, （4.3±1.4）,（23.2±6.3） points, P 〈 0.05]. CONCLUSION： Nerve block can ameliorate the painful status of patients with iliohypogastric neuralgia, and the relief of pain can improve the depressive status and ill-emotion of the patients. Nerve block in treating iliohypogastric neuralgia has beth analgesic effect, also plays a role in ameliorating the depressive emotion.
出处
《中国临床康复》
CSCD
北大核心
2005年第24期47-49,共3页
Chinese Journal of Clinical Rehabilitation
