5%葡萄糖注射治疗疼痛性疾病的研究进展

Research progress on the application of 5% dextrose water injection in the treatment of painful conditions

摘要:

近年来微创介入技术在疼痛科迅猛发展，影像学引导下的精准注射已日臻成熟并广泛应用。糖皮质激素（glucocorticoids, GCs）作为注射治疗中最为常用的药物，能够迅速抑制炎症、缓解疼痛，但其血糖升高、组织萎缩、肌腱断裂和骨钙丢失等副作用以及反复注射后疗效递减限制了其长期应用。5%葡萄糖注射液（5% dextrose water, D5W）神经水分离疗法是一种新型非药物、非激素和非毁损的微创介入手段，能迅速松解神经粘连、改善局部微循环、抑制神经源性炎症并促进神经修复，从而有效缓解疼痛。本文通过总结近年来国内外关于D5W在腕管综合征、肘管综合征、枕神经痛以及腰脊神经后支卡压综合征等疼痛性疾病中应用研究，对其镇痛机制、应用现状以及安全性进行综述，旨在为规范疼痛治疗、减少激素依赖提供循证依据。

Abstract:

Minimally invasive interventional techniques have developed rapidly in the field of pain management, and image-guided precise injections have become increasingly sophisticated and widely applied. Glucocorticoids (GCs), the most commonly used agents in injection therapy, can rapidly inhibit inflammation and relieve pain. However, long-term application of GCs is limited by side effects such as elevated blood glucose, tissue atrophy, tendon rupture, and calcium loss, as well as diminishing efficacy after repeated injections. Nerve hydrodissection with 5% dextrose water (D5W) is a novel minimally invasive method that is non-pharmacological, non-GCs, and non-ablative. It can quickly separate perineural adhesions, augments local microcirculation, suppresses neuroinflammation, and accelerates neural repair, thereby effectively relieving pain. Here, we review the domestic and international literature on the application of D5W in painful disorders, including carpal tunnel syndrome, cubital tunnel syndrome, occipital neuralgia, and posterior ramus entrapment syndrome, with specific emphasis on its analgesic mechanisms, current applications and safety profile, aiming to provide evidence-based guidance for standardizing pain management while minimizing the dependence of GCs.