运动皮层电刺激治疗卒中后中枢性疼痛的疗效分析

THE EFFECTS OF MOTOR CORTEX STIMULATION ON CENTRAL POST STROKE PAIN

目的：评价运动皮层电刺激（motor cortex stimulation,MCS）治疗卒中后中枢性疼痛（central post stroke pain,CPSP）的疼痛缓解情况及生活质量改善情况。方法：随访2005年2月至2013年7月于首都医科大学宣武医院功能神经外科行MCS治疗的CPSP患者17例,记录患者术前及术后2周的疼痛视觉模拟评分（Visual Analogue Scale,VAS）和术后2周、3月、6月、1年及最后随访时间的疼痛缓解率（0%~100%）;采用SF-36生活质量评分量表（Short Form-36）来评价患者手术前后的生活质量情况;疼痛缓解≥25%认为手术有效。结果：术前患者VAS评分为9.3±0.6,术后2周时为4.9±2.3,术后较术前相比有显著差异（P〈0.001）;手术后2周时有效的患者占82.4%,3月时有效的患者占64.7%,6月时有效的患者占56.3%,1年时有效的患者占40.0%,最后随访时间时有效的患者占33.3%;随访到9例患者完整的生活质量情况,术后较术前有显著改善（P=0.02）。结论：MCS治疗CPSP有效,并能改善大部分患者的生活质量;MCS具有创伤小、并发症少等优点;术后刺激参数的调节对疗效的影响至关重要。

Objective： To evaluate the effects of motor cortex stimulation（MCS） on central post stroke pain（CPSP）. Methods： 17 consecutive patients were referred to our institution between February 2005 and July 2013 to undergo MCS for central post stroke pain. Visual Analogue Scale（VAS） was used for pain assessment before and two weeks after surgery. Oral report pain relief（0% ~ 100%） was used before and 2 weeks, 3 months, 6 months, 1 year after surgery and the end of the follow-up period. Quality of life score was recorded with Short Form-36（SF-36） before and after surgery. Results： The average score of VAS before MCS was 9.3±0.6, 2 weeks after MCS, the average score of VAS was 4.9±2.3. Of which, 82.4%, 64.7%, 56.3%, and 40.0% of patients got fair pain relief 2 weeks and 3, 6, and 12 months after surgery, respectively. However, the rate declined to 33.3% at the end of the follow-up period. Nine patients were followed up about quality of life, the scores of SF-36 have significant improvement after the surgery（P = 0.02）. Conclusions： MCS is an effective neurosurgical procedure to relieve central post stroke pain, and most patients＇ life quality was greatly enhanced after MCS. MCS is an invasive surgical method with little complications for the treatment of the central post stroke pain. It is very important to adjust the stimulation parameters after surgery to obtain satisfactory pain relief.