硬膜外腔注射地塞米松棕榈酸酯对代谢和内分泌系统的影响

Metabolic and endocrinal effects of epidural dexamethasone palmitate injection

目的观察单次硬膜外腔注射不同剂量地塞米松棕榈酸酯对腰椎间盘突出症患者血糖、血脂及下丘脑-垂体-肾上腺皮质轴的影响。方法选择2016年7月至2018年1月在河北医科大学第二医院疼痛科住院的腰椎间盘突出症患者40例,男性23例,女性17例,年龄30~80岁,在硬膜外腔单次注射地塞米松棕榈酸酯治疗。根据注射剂量不同,随机分为2组:A组20例:在硬膜外腔受累神经附近注射地塞米松棕榈酸酯4mg;B组20例:在硬膜外腔受累神经附近注射地塞米松棕榈酸酯8mg。记录各组患者治疗前与治疗后1w,1个月与3个月的疼痛视觉模拟评分(VAS),Oswestry功能障碍指数(ODI),治疗前(T0)和治疗后第2天(T1)、4天(T2)、7天(T3)、14天(T4)及21天(T5)抽血测定空腹血糖、餐后2h血糖、血浆总胆固醇、三酰甘油、血浆皮质醇、促肾上腺皮质激素(ACTH)浓度。结果与T0相比,两组患者治疗后1 w,1个月与3个月VAS降低(P<0.01),ODI评分降低(P<0.01),两组间比较差异无统计学意义(P>0.05);与T0相比,两组患者T1、T2、T3时点晨空腹血糖及餐后2h血糖升高(P<0.05),T4时点恢复正常;总胆固醇及三酰甘油治疗前后比较差异无统计学意义(P>0.05);两组患者T1、T2、T3及T4时点的皮质醇及ACTH降低(P<0.01),T5时点恢复。结论单次硬膜外腔注射地塞米松棕榈酸酯4mg与8mg均能改善腰椎间盘突出症患者疼痛症状与功能障碍;1 w空腹血糖及餐后2 h血糖升高,2 w恢复至治疗前水平;2 w皮质醇及ACTH降低,3 w恢复至治疗前水平;对血脂无影响。

Objective To observe the effects of a single dose of dexamethasone palmitate epidural injection on blood glucose,blood lipid and HPA axis.Methods From July 2016 to January 2018,40 patients(male 23,female 17)with lumbar disc herniation who were hospitalized in the department of pain management,the second hospital of Hebei Medical University enrolled in this study,aged from 30-80 years.They were treated with a single epidural injection of dexamethasone palmitate.According to the dose,they were divided into 2 groups randomly:group A and group B were injected with dexamethasone palmitate 4 mg and 8 mg respectively.The visual analog scale(VAS)and the Oswestry disability index(ODI)were recorded before and 1 week,1 month and 3 months after treatment,fasting blood glucose(FBG),2-hour postprandial blood glucose(2 hPG),plasma total cholesterol,triglyceride,plasma cortisol,adreno cortico tropic hormone(ACTH)were measured before treatment(T0)and 2 days(T1),4 days(T2),7 days(T3),14 days(T4)and 21 days(T5)after treatment.Results Compared with T0,the VAS and ODI scores of the 2 groups decreased at 1 week,1 month and 3 months after treatment(P<0.01).There was no significant difference between the 2 groups(P>0.05).Compared with T0,the fasting blood glucose and 2-hour postprandial blood glucose increased at T1,T2 and T3 in 2 groups(P<0.01),and returned to normal at T4;there was no significant difference in total cholesterol and triglyceride(P>0.05);the cortisol and ACTH decreased at T1,T2,T3 and T4 in 2 groups(P<0.01),and recovered at T5.Conclusions A single epidural injection of 4 mg and 8 mg of dexamethasone palmitate can alleviate pain of the patients with lumbar disc herniation.FBG and 2 hPG increase in 1 week;plasma cortisol and ACTH decrease in 2 weeks.