静脉输注利多卡因对脉冲射频治疗相关疼痛的影响*

Effects of intravenous lidocaine on pain related pulsed radiofrequency therapy

摘要:

目的：对脉冲射频 (pulsed radiofrequency, PRF) 治疗相关疼痛进行调查并探讨静脉输注利多卡因对其的影响。 方法：选取接受PRF治疗的206例病人进行调研，记录术前、术中、术后0、1、2小时 (T0、T1、T2、T3、T4) 的视觉模拟评分法 (visual analogue scale, VAS) 评分、心率（Heart rate, HR）、平均动脉压 (mean arterial pressure, MAP) ，在术后记录病人的满意度以及需要使用血管活性药的例数。选取三叉神经痛和颈源性头痛病人各30例，根据是否静脉输注利多卡因分为 利多卡因组（L组 = 30）和对照组（C组 = 30）。记录术前、术中、术后0、1、24小时的(t0、t1、t2、t3、t4) VAS评分、HR、MAP及满意度 ；于t0、t3、t4取静脉血测白细胞介素1β (interleukin 1β, IL-1β)、肿瘤坏死因子-α (tumor necrosis factor-α, TNF-α) 及去甲肾上腺素 (norepinephrine, NE) 含量。记录不良反应发生情况。结果：PRF治疗时VAS评分、HR和MAP升高 ，满意度34.5% 。PRF治疗时，三叉神经、C2背根神经节VAS评分高于其他组 。在利多卡因静脉输注研究中，t1、t3、t4时L组VAS评分显著低于C组；t1、t2时L组MAP、HR显著低于C组。t4时L组IL-1β、TNF-α含量显著低于C组；t2时L组NE含量显著低于C组。L组满意度显著高于C组，两组不良反应差异无统计学意义。结论：静脉输注利多卡因通过降低机体炎症应激反应减轻PRF治疗相关疼痛。

Abstract:

Objective: To investigate the status of pain associated with pulsed radiofrequency (PRF) therapy and explore the effects of intravenous lidocaine on pain. Methods: 206 patients who received PRF treatment were selected for investigation. The visual analog scale (VAS) scores, heart rate (HR) and mean arterial pressure (MAP) were recorded before, during and at 0, 1 and 2 hours after the operation (T0, T1, T2, T3 and T4). Patient satisfaction and the number of cases requiring vasoactive drugs were also recorded. 30 patients diagnosed with trigeminal neuralgia and 30 patients with cervicogenic headache were selected and divided into lidocaine group (group L = 30) and control group (group C = 30) by whether injecting lidocaine. VAS scores, HR and MAP were recorded before, during and at 0, 1, and 24 hours after operation (t0, t1, t2, t3, and t4). The satisfaction related with PRF treatment were noted after PRF treatment. Venous blood was taken at t0, t2, and t4 to measure interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and norepinephrine (NE) content. Results: Compared with other time, VAS score, HR and MAP were increased during PRF treatment . The VAS score of group L was lower than that of group C at t1, t3 and t4. At t1 and t2, the MAP and HR of group L were lower than those of group C. The concentration of IL-1β and TNF-α in group L were lower than those in group C at t4; the level of NE in group L was lower than that in group C at t2. The rate of satisfaction in group L was significantly higher than that in group C. There was no significant difference in adverse reactions between two groups. Conclusions: Intravenous infusion of lidocaine can reduce PRF-related pain by reducing the inflammatory factors.