不同剂量糖皮质激素硬膜外注射治疗椎间盘源性根痛的临床研究

Clinical study on the efficiency of epidural injection with different doses glucocorticoids in radicular pain associated with lumbar disc herniation*

摘要:

目的：本研究为一项前瞻性、观察性试验。观察不同剂量甲泼尼龙硬膜外注射（epidural injections, EI）治疗腰椎间盘源性根性痛的有效性和安全性，探讨甲泼尼龙EI治疗的合适剂量。方法：选取2022年1月至2022年7月因腰椎盘突出导致根性疼痛于我科就诊的病人93例，根据甲泼尼龙EI使用剂量分为A组（10mg）、B组（20mg）和C组（40mg），比较三组术前、术后1、2、3天和7天疼痛程度（numerical rating scale, NRS)评分，术前、术后1天空腹血糖、血清促肾上腺皮质激素（Adrenocorticotropic hormone, ACTH）和血清皮质醇水平的差值，并分析影响疼痛有效缓解的相关因素。结果：与术前相比，各组病人术后各时间点NRS评分均明显降低（P<0.001），术后7天B、C两组病人NRS明显低于A组（P<0.01）。术前NRS和糖皮质激素剂量为影响术后7天疼痛有效缓解的独立危险因素。术前与术后1天空腹血糖、血清皮质醇、ACTH水平差值三组间存在差异，且C组>B组>A组。三组不良反应发生率无明显差异。结论：20 mg甲泼尼龙EI 治疗椎间盘源性根痛与40 mg疗效相当，优于10mg，3组不良反应发生率无差异。且更小的剂量能降低甲泼尼龙对相关激素及血糖的影响；术后7天时术前中度疼痛病人较重度疼痛者疗效更好。

Abstract:

Objective: This study is a prospective and observational trial. To observe the efficacy and safety of different doses of methylprednisolone epidural injection（EI）in the treatment of lumbar intervertebral disc radicular pain, and to explore the appropriate dose of EI treatment with methylprednisolone. Methods: 93 patients with radicular pain caused by lumbar disc herniation from January 2022 to July 2022 were divided into group A (10mg), group B (20mg) and group C (40mg) according to the dosage of EI with methylprednisolone. The numerical rating scale (NRS) scores of the three groups were compared before operation, 1, 2, 3 and 7 days after operation. The differences of finger stick blood glucose, serum concentration in adrenocorticotropic hormone (ACTH) and serum cortisol concentration before and 1 day after operation were analyzed.And the related factors who affecting effective pain relief were still analyzed. Results: Compared with before operation point, the NRS score of each group decreased significantly at each time point after operation (P<0.001). On the day 7 after operation, the NRS of group B and C was significantly lower than that of group A (P<0.05). Preoperative NRS and glucocorticoid dose were independent risk factors for effective pain relief 7 days after operation. The differences in finger stick blood glucose, serum cortisol and ACTH concentration among the three groups before operation and 1 day after operation were significant different, and group C > group B > group A. There was no significant difference in the incidence of adverse reactions among the three groups. Conclusion: EI with the dose of 20mg methylprednisolone has the same efficacy as 40mg in the treatment of radicular pain associated with lumbar disc herniation, superior to 10mg. There was no difference in the incidence of adverse reactions among the three groups. And smaller dosage can reduce the effect of methylprednisolone on related hormones and blood glucose. At 7 days after operation, the curative effect of patients with moderate pain was better than that of patients with severe pain.