普瑞巴林治疗椎体成形术后疼痛缓解不明显患者的疗效分析
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摘要
目的 探讨普瑞巴林对经皮穿刺椎体成形(PVP)术后疼痛缓解不明显患者的疗效。方法 前瞻性纳入2014年3月—2018年3月来重庆市九龙坡区第二人民医院就诊的骨质疏松性椎体压缩骨折(OVCF)患者195例,均接受PVP手术治疗。采用VAS评分对术前和术后1d的疼痛情况进行评估,纳入术后疼痛改善率<25%的患者给予普瑞巴林治疗,起始剂量为75mg,2次/d;服药1周内根据疼痛缓解情况和患者对药物的耐受情况,调整到150mg,2次/d,剂量调整后再服用1～2周,若疼痛还未完全缓解且患者对药物耐受情况较好,可最大调整到300mg,2次/d。在第4周时,每2天剂量减半,直至采用起始剂量维持到最后停药。整个药物治疗周期为4周。结果 共纳入了18例患者进行术后普瑞巴林治疗,该组患者PVP术后1d的VAS、HAD焦虑(HAD-A)、HAD抑郁(HAD-D)、匹兹堡睡眠指数(PSQI)评分分别为6.15±1.68、8.94±0.67、8.26±0.55、16.85±2.12;而在服药4周后,上述指标均得到显著改善,分别为3.28±0.42、5.17±0.38、4.64±0.38、8.25±1.02,差异有统计学意义(P﹤0.05)。药物不良反应率为16.67%(3/18),对症处理后均缓解。结论 PVP术后疼痛症状缓解不明显的患者可采用普瑞巴林治疗,具有较好的疗效及安全性。
Objective To investigate the effect of pregabalin on the pain relief of patients after percutaneous vertebroplasty(PVP) treatment. Methods From Mar. 2014 to Mar. 2018,195 patients with OVCF receiving PVP treatment in the Department of Orthopedics,Chongqing Jiulongpo Second People's Hospital were prospectively enrolled. The visual analogue scale(VAS) for pain assessment was recorded before operation and 1 day after operation,respectively. If the pain relief rate was less than 25% postoperatively,these patients would take pregabalin at a dose of 75 mg,bid;on the first week,it could be adjusted to a dose of 150 mg,bid according to pain relief and drug tolerance,and this dose continued for one or two weeks; then,if the pain relief was not adequate but drug tolerance was good,it could be adjusted to a maximum dose of 300 mg,bid; on the fourth week,patients would be given the half dose every two days,finally initial dose maintenance until drug discontinuance. The whole medication cycle was four weeks. The VAS,hospital anxiety and depression scale(HAD) and Pittsburgh sleep quality index(PSQI)were used to compare the pain,emotion and sleep quality before and after pregabalin treatment. The adverse drug reaction was also recorded during follow-up. Results A total of 18 patients were included into this study for pregabalin treatment. At 1 day after operation,the VAS,HAD-anxiety(HAD-A),HAD-depression(HAD-D) and PSQI scores were 7.46±1.34,8.94±0.67,8.26±0.55,16.85±2.12, respectively. Furthermore,after 4 weeks of pregabalin treatment, these aforementioned indexes were significantly improved to 3.28±0.42,5.17±0.38,4.64±0.38,8.25±1.02,respectively,with statistical difference. The adverse drug reaction rate was 16.67%(3/18),which was relieved after symptomatic treatment. Conclusion Pregabalin is effective for the poor pain relief after PVP treatment,which has relative safety and certain efficacy.
Objective To investigate the effect of pregabalin on the pain relief of patients after percutaneous vertebroplasty(PVP) treatment. Methods From Mar. 2014 to Mar. 2018,195 patients with OVCF receiving PVP treatment in the Department of Orthopedics,Chongqing Jiulongpo Second People's Hospital were prospectively enrolled. The visual analogue scale(VAS) for pain assessment was recorded before operation and 1 day after operation,respectively. If the pain relief rate was less than 25% postoperatively,these patients would take pregabalin at a dose of 75 mg,bid;on the first week,it could be adjusted to a dose of 150 mg,bid according to pain relief and drug tolerance,and this dose continued for one or two weeks; then,if the pain relief was not adequate but drug tolerance was good,it could be adjusted to a maximum dose of 300 mg,bid; on the fourth week,patients would be given the half dose every two days,finally initial dose maintenance until drug discontinuance. The whole medication cycle was four weeks. The VAS,hospital anxiety and depression scale(HAD) and Pittsburgh sleep quality index(PSQI)were used to compare the pain,emotion and sleep quality before and after pregabalin treatment. The adverse drug reaction was also recorded during follow-up. Results A total of 18 patients were included into this study for pregabalin treatment. At 1 day after operation,the VAS,HAD-anxiety(HAD-A),HAD-depression(HAD-D) and PSQI scores were 7.46±1.34,8.94±0.67,8.26±0.55,16.85±2.12, respectively. Furthermore,after 4 weeks of pregabalin treatment, these aforementioned indexes were significantly improved to 3.28±0.42,5.17±0.38,4.64±0.38,8.25±1.02,respectively,with statistical difference. The adverse drug reaction rate was 16.67%(3/18),which was relieved after symptomatic treatment. Conclusion Pregabalin is effective for the poor pain relief after PVP treatment,which has relative safety and certain efficacy.
引文
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[6] 龚为群,阎萍,杨世权,等.Epworth嗜睡量表联合匹兹堡睡眠质量指数量表在不同程度鼻源性OSAHS患者中的临床应用[J].重庆医学,2016,45(32):4549-4551.
[7] Zuo XH,Zhu XP,Bao HG,et al.Network meta-analysis of percutaneous vertebroplasty,percutaneous kyphoplasty,nerve block,and conservative treatment for nonsurgery options of acute/subacute and chronic osteoporotic vertebral compression fractures (OVCFs) in short-term and long-term effects[J].Medicine (Baltimore),2018,97(29):e11544.
[8] 韦武,宁金沛,李泉,等.椎体成形术后疼痛缓解不佳的原因分析及对策 [J].实用骨科杂志,2013,19(7):639-641.
[9] Muijs SP,Van Erkel AR,Dijkstra PD.Treatment of painful osteoporotic vertebral compression fractures:a brief review of the evidence for percutaneous vertebroplasty [J].J Bone Joint Surg(Br),2011,93(9):1149-1153.
[10] Coderre TJ.Topical drug therapeutics for neuropathic pain[J].Expert Opin Pharmacother,2018,19(11):1211-1220.
[11] 郑静怡,童本定,丁选胜,等.普瑞巴林治疗神经病理性疼痛的Meta分析 [J].西北药学杂志,2014,29(6):629-633.
[12] Gianesello L,Pavoni V,Barboni E,et al.Perioperative pregabalin for postoperative pain control and quality of life after major spinal surgery[J].J Neurosurg Anesthesiol,2012,24(2):121-126.
[13] 倪雪珺,杜冬萍.神经病理性疼痛与抑郁和焦虑精神症状的相关性[J].上海交通大学学报(医学版),2013,33(1):67-70.
[14] 李爱林.普瑞巴林治疗神经病理性疼痛的疗效和安全性研究[J].中医临床研究,2018,10(4):121-122.
[2] Buchbinder R,Osborne RH,Ebeling PR,et al.A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures[J].N Engl j Med,2009,361(6):557-568.
[3] Kallmes DF,Comstock BA,Heagerty PJ,et al.A randomized trial of vertebroplasty for osteoporotic spinal fractures[J].N Engl J Med,2009,361(6):569-579.
[4] Alles SRA,Smith PA.Etiology and pharmacology of neuropathic pain[J].Pharmacol Rev,2018,70(2):315-347.
[5] 薛鹏飞,崔志明.术前心理评估量表的应用[J].中华临床医师杂志(电子版),2017,11(16):2140-2143.
[6] 龚为群,阎萍,杨世权,等.Epworth嗜睡量表联合匹兹堡睡眠质量指数量表在不同程度鼻源性OSAHS患者中的临床应用[J].重庆医学,2016,45(32):4549-4551.
[7] Zuo XH,Zhu XP,Bao HG,et al.Network meta-analysis of percutaneous vertebroplasty,percutaneous kyphoplasty,nerve block,and conservative treatment for nonsurgery options of acute/subacute and chronic osteoporotic vertebral compression fractures (OVCFs) in short-term and long-term effects[J].Medicine (Baltimore),2018,97(29):e11544.
[8] 韦武,宁金沛,李泉,等.椎体成形术后疼痛缓解不佳的原因分析及对策 [J].实用骨科杂志,2013,19(7):639-641.
[9] Muijs SP,Van Erkel AR,Dijkstra PD.Treatment of painful osteoporotic vertebral compression fractures:a brief review of the evidence for percutaneous vertebroplasty [J].J Bone Joint Surg(Br),2011,93(9):1149-1153.
[10] Coderre TJ.Topical drug therapeutics for neuropathic pain[J].Expert Opin Pharmacother,2018,19(11):1211-1220.
[11] 郑静怡,童本定,丁选胜,等.普瑞巴林治疗神经病理性疼痛的Meta分析 [J].西北药学杂志,2014,29(6):629-633.
[12] Gianesello L,Pavoni V,Barboni E,et al.Perioperative pregabalin for postoperative pain control and quality of life after major spinal surgery[J].J Neurosurg Anesthesiol,2012,24(2):121-126.
[13] 倪雪珺,杜冬萍.神经病理性疼痛与抑郁和焦虑精神症状的相关性[J].上海交通大学学报(医学版),2013,33(1):67-70.
[14] 李爱林.普瑞巴林治疗神经病理性疼痛的疗效和安全性研究[J].中医临床研究,2018,10(4):121-122.