连续硬膜外腔阻滞联合普瑞巴林治疗糖尿病周围神经病变

CLINICAL STUDY OF EPIDURAL BLOCK COMBINED WITH PREGABALIN IN THE TREATMENT OF DIABETIC PERIPHERAL NEUROPATHY

目的:观察连续硬膜外腔阻滞联合普瑞巴林对糖尿病周围神经病变的治疗效果。方法:选择36例糖尿病周围神经病变患者,随机分为两组:A组(n=18)每日口服普瑞巴林300 mg;B组(n=18)每日口服普瑞巴林300 mg联合0.6%利多卡因连续硬膜外腔阻滞。比较治疗后八周两组患者疼痛视觉评分(visual analogue scale,VAS)的变化、下肢神经传导速度变化及不良反应的发生情况。结果:A组治疗1周后VAS评分开始下降,此后各时间点VAS评分均低于治疗前(P<0.05);B组治疗后各时间点VAS评分均明显低于治疗前(P<0.05)。与A组相比,除第8周外,B组各时间点VAS评分均明显低于A组(P<0.05)。两组患者治疗8周后腓总神经、腓肠神经运动传导速度(motorconduction velocity,MCV)及感觉神经传导速度(sensory nerve conduction velocity,SCV)均有明显改善(P<0.05),但B组显著优于A组(P<0.05)。B组头晕、嗜睡等不良反应发生率与A组相比无显著差异(P>0.05)。结论:连续硬膜外阻滞联合普瑞巴林治疗糖尿病周围神经病变起效快,疗效持久,副作用少。

Objective： To investigate the effects of continuous epidural block combined with pregabalin in the treatment of diabetic peripheral neuropathy. Methods： 36 patients with diabetic peripheral neuropathy were randomly divided into two groups. Group A （n = 18）： daily oral pregabalin 300 mg; Group B （n = 18）： daily oral pregabalin 300 mg combined with 0.6% lidocaine continuous epidural infusion. Visual analogue scale （VAS）, lower extremity pain changes, nerve conduction changes and adverse reactions were recorded in eight weeks. Results： The VAS score in group A began to decline after one week, and then it was obviously lower than before treatment at each time point after therapy （P 〈 0.05）. But the VAS score in Group B was significantly lower than before treatment at any time point （P 〈 0.05）. Compared with Group A, the VAS score in B group at each time point was significantly lower than that in group A except the eighth week （P 〈 0.05）. After 8-week therapy, the electromyography showed motor conduction velocity （MCV） and sensory nerve conduction velocity （SCV） improved significantly in two groups than before therapy （P 〈 0.05）. Group B was much better than group A （P 〈 0.05）. There was no significant difference in the incidence of aversive side effects between group A and 13 （P 〉 0.05）. Conclusion： Continuous epidural block combined with pregabalin in the treatment of diabetic peripheral neuropathy provides a more rapid onset of pain relief, satisfying analgesia and has lower incidence of adverse effects.