红外热像图评估腰大肌肌沟注入空气对神经阻滞药物扩散范围及止痛效果的作用

Assessing psoas compartment block with air injection effects on sciatica and drug dispersion using infrared thermography

背景：红外热像学利用红外线辐射成像原理观察人体表面温度变化，从而反映人体生理病理现象。目的：应用红外热像图评估比较腰大肌肌沟注入与不注入空气行利多卡因阻滞药物扩散范围及止痛效果。设计、时间及地点：同期非随机分组对照观察，于2005年在延边医学院附属医院完成。对象：选择2005-01／12延边医学院附属医院疼痛科住院的L3～S1腰椎间盘突出引起坐骨神经痛而未达到手术指征的32例患者。分为不注空气组15例，注空气组17例，2组患者在性别、年龄方面差异无显著性（P〉0．05）。方法：两组患者均在CT引导下行腰大肌肌沟利多卡因阻滞。CT扫描确认针尖的位置在腰大肌肌沟后，注气组回抽无液无血时推注20mL的空气，两组患者均给予15g/L利多卡因20mL缓慢推注。1次/d，12d为1个疗程。主要观察指标：①观察进针深度、药物扩散范围及治疗前、推药后20min和疗程结束后采用红外热像图仪测试双下肢温差。②治疗前后采用目测类比评分（VAS）法进行疼痛评分。结果：①男性和女性进针深度差异无显著性意义[（6．2±0．7）cm，（5．8±0．6）cm，P〉0．05]。②CT扫描观察注空气组药物扩散范围大于不注空气组（P〈0．01）。③不注空气组双下肢温差治疗前、推药后20min及疗程结束后差异均有显著性意义[依次为（0．69±0．66），（0．33±0．14），（0．34±0．16）℃，P〈0．05]；注空气组双下肢温差治疗前、推药后20min和疗程结束后差异均有显著性意义（依次为（0．53±0．19），（0．32±0．21），（0．24±0．14）℃，P〈0．05）：两组之间治疗后差异均无显著性意义（P〉0．05）。④两组治疗后VAS评分均较治疗前明显下降，（P〈0．05），治疗后组间比较差异无显著性意义（P〉0．05）。结论：注入和不注入空气行腰大肌肌沟神经阻滞治疗坐骨神经痛，药物扩散范围有差异性，但疗效无明显差异。

BACKGROUND： Infrared thermography is to observe human body surface temperature changes by infrared radiation imaging to reflect human body physiological and pathological conditions. OBJECTIVE： To evaluate the drug dispersion and pain relief effect by psoas compartment block with or without air by thermograpey. DESIGN, TIME AND SETTING： Non-randomized concurrent control trial was performed at the Affiliated Hospital of Yanbian Medical College in 2005. PARTICIPANTS： Thirty-two patients with sciatica caused by lumbar intervertebral disc herniation at L3-S1 were selected from Department of Anesthesiology ＆ Pain Medicine, Affiliated Hospital of Yanbian Medical College from January to December 2005. They were randomly divided into airless group （n =15） and air injection group （n =17）. There were no significant differences between two groups in terms of gender and age （P 〉 0.05）. METHODS： All patients were injected lidocaine in psoas muscles under CT guidance. The puncture point was confirmed by CT scanning, and the air injection group was injected 20 mL air when there was no liquid or blood after pumpback. 20 mL lidocaine （15 g/L） was injected into two groups, once per day, 12 days as one course. MAIN OUTCOME MEASURES： Puncture depth, drug dispersion range, and temperature changes of both lower extremities 20 minutes after injection and the end of treatment course were measured. The pain degree was evaluated by visual analog scale （VAS） before and after treatment. RESULTS： There were no significant differences in puncture depth between male and female [（6.2±0.7） cm, （5.8±0.6） cm, P 〉 0.05]. Drug dispersion range in air injection group was significantly larger that that in airless group （P 〈 0.01）. Significant differences were observed in the temperature of both lower extremities in airless group before treatment, 20 minutes after injection and the end of treatment [（0.69±0.66）, （0.33±0.14）, （0.34±0.16） ℃, P 〈 0.05]; there were also significant differences in the temperature of both lower extremities in air injection group before treatment, 20 minutes after injection and the end of treatment [（0.53±0.19）, （0.32±0.21）, （0.24±0.14） ℃, P 〈 0.05]. After one course of treatment, the scores for VAS were significantly decreased than before treatment （P 〈 0.05）, but no significant differences were found in intragroup comparison （P 〉 0.05）. CONCLUSION： The treatment of sciatica by psoas compartment block with or without air shows a difference in drug dispersion range, but the curative effect is similar.