天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (9): 980-983.

• 临床研究 • 上一篇    下一篇

经颅直流电刺激治疗腰椎融合术后疼痛的疗效观察

张春虹 1，闫兵山 1,2，徐宝山 1，马信龙 1，杨强 1，刘越 1   

  1. 1 天津市天津医院微创脊柱外科（邮编 300211）；2 天津医科大学研究生院
  • 收稿日期:2017-08-04 修回日期:2017-08-21 出版日期:2017-09-15 发布日期:2017-09-25
  • 通讯作者: 张春虹 E-mail:zhangchunhong718@163.com

The observation of curative effect of transcranial direct current stimulation on the treatment of pain after lumbar fusion operation

ZHANG Chun-hong1, YAN Bing-shan1，2, XU Bao-shan1, MA Xin-long1, YANG Qiang1, LIU Yue1   

  • Received:2017-08-04 Revised:2017-08-21 Published:2017-09-15 Online:2017-09-25
  • Contact: Chun-Hong ZHANG E-mail:zhangchunhong718@163.com

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摘要： 摘要：目的 观察经颅直流电刺激（tDCS）治疗腰椎融合术后疼痛的临床疗效。方法 回顾性分析 2016 年 1 月— 12 月天津医院微创脊柱外科接受腰椎融合手术的患者资料。根据术后给予的镇痛策略分为 tDCS 组和对照组，tDCS 组患者给予氟比洛芬酯注射液联合 tDCS 控制术后疼痛，必要时使用吗啡控制爆发性疼痛；对照组给予氟比洛芬酯 联合吗啡镇痛。记录患者术前及术后疼痛视觉模拟评分（VAS）、功能障碍指数评分（ODI）、阿片类药物使用量及治 疗相关并发症等指标。结果 共纳入 42 例。tDCS 组 22 例，平均年龄（56.7±10.5）岁；对照组 20 例，平均年龄（60.3± 9.2）岁。2 组患者术前 VAS、ODI 评分差异无统计学意义。2 组患者术后 24 h 及出院时疼痛 VAS 评分、ODI 与同组 内术前相比明显改善；与对照组相比，tDCS 组患者术后 24 h VAS 评分（2.0±1.7）、出院时 VAS 评分（2.1±0.9）以及出 院时 ODI （20.9±6.5）明显低于对照组（3.3±1.4，2.9±1.3，25.4±5.3），差异有统计学意义。采用 tDCS 联合阿片类药物控 制术后暴发性疼痛，可减少约 25%阿片类药物的使用量（P＜0.01），而并发症仅为电极粘贴部位的瘙痒、疼痛、灼热及 刺痛。结论 在腰椎融合术后患者中使用经颅直流电刺激可降低患者疼痛、减少麻醉药物使用、促进患者快速康 复，不会增加相关并发症的发生率，具有替代阿片类药物治疗疼痛的潜在可能性。

关键词: 脊柱融合术, 腰椎, 镇痛, 镇痛药, 阿片类, 经颅直流电刺激, 脊柱退变性疾病

Abstract: Abstract: Objective To observe the effect of transcranial direct current stimulation (tDCS) on the treatment of pain after lumbar fusion operation. Methods Patients who underwent lumbar fusion surgery from January 2016 to December 2016 were retrospective analysed in Department of Minimally Invasive Spine Surgery, Tianjin Hospital. They were divided into experimental group and control group according to the postoperative analgesic strategies, the experimental group was treated with tDCS combined with opioid after surgery to control postoperative pain and the control group only received opioids. The data of preoperative and postoperative pain visual analogue score (VAS), oswestry disability index (ODI), opioid analgesics usage and complications were recorded. Results 42 patients were included and 22 in experimental group (the mean age 56.7±10.5) and 20 in control group (the mean age 60.3±9.2). All the patients completed the study successfully. There were no significant differences in terms of preoperative VAS and ODI score between two groups. The postoperative 24h VAS (2.0 ± 1.7) and VAS (2.1±0.9) at discharge in experimental group were significantly lower than those in control group (3.3±1.4, 2.9±1.3), the difference was statistically significant. The functional recovery was more quickly in experimental group than that in control group (ODI score 20.9±6.5 in experimental group and 25.4±5.3 in control group, P = 0.02). Compared with control group, the experimental group can reduce about 25% of opioid usage. There was no significant difference in the incidence of complications between the two groups (experimental group: 2/22, control group: 3/18, P > 0.05). The discomfort sensations reported in tDCS includeding itching under the electrodes, pain, warmth and stinging. No other adverse reactions and serious complications were observed. Conclusion The use of transcranial direct current stimulation after lumbar fusion can decrease the pain sensation, reduce the usage of opioids drugs, promote the rehabilitation of patients and wound not increase the incidence of complication. has the potential probability to replace opioids for chronic pain. Using transcranial direct current stimulation can reduce pain in patients after lumbar fusion, reduce the use of narcotic drugs, promote the rehabilitation of patients, was not increased, has the potential to replace opioids for chronic pain.

Key words: spinal fusion, lumbar vertebrae, analgesia, analgesics, opioid, transcranial direct current stimulation, degenerative spinal disease