阿米替林治疗脑卒中后中枢痛的疗效和耐受性分析

Analysis of Curative Effect and Tolerability of Amitriptyline in the Treatment of Central Pain after Stroke

目的 观察阿米替林治疗脑卒中后中枢痛的效果和不良反应,分析其耐受性。方法 入组90例2014年1月～2015年1月在我院治疗的脑卒中患者,所有患者疼痛持续时间均超过3个月,随机分为观察组（n=45）和对照组（n=45）。观察组患者给予阿米替林25mg（2次/d）,对照组患者给予复合维生素B片3片（3次/d）,疗程4周。所有患者治疗前和治疗后3d、1周、2周、4周分别进行视觉模拟评分（VAS）和疼痛缓解度（PAR）测定,比较两组患者治疗前后VAS评分、疼痛缓解总有效率和不良反应耐受情况。结果 两组患者治疗后第4周VAS评分均较治疗前显著降低（P均〈0.05）;观察组患者治疗后1周、2周、4周VAS评分较对照组显著降低（P〈0.05）;观察组患者第4周疼痛总缓解率为84.4%,显著高于对照组第4周疼痛总缓解率35.6%（P〈0.05）;观察组不良反应主要为头晕、口干和视物模糊,对症治疗后,不良症状均可快速缓解。结论 阿米替林治疗脑卒中后中枢痛疗效显著,耐受性良好。

Objective To observe the curative effect and adverse reactions of amitriptyline in the treatment of central pain after stroke and analyze the tolerability of amitriptyline. Methods 90 patients with central pain after stroke Who were admitted to our hospital from January 2014 tO January 2015 were selected in this study. The duration of pain of all patients was more than 3 months. These patients were randomly divided into the observation group and the control group with 45 in each. Patients in the observation group were treated with amitriptyline 25 mg for twice a day while patients in the control group were treated with 3 pieces of compound vitamins B tablets for three times a day. The course of treatment was 4 weeks. All patients were received detection of visual analogue scale （VAS） and the pain relief rate （PAR） 3 days, 1, 2, 4 weeks before and after treatment respectively. The VAS score, total effective rate of pain relief and the tolerability of adverse reactions before and after treatment between the two groups were compared. Results VAS scores at the fourth week after treatment of two groups were both significantly lower than that before treatment （P 〈 0.05）. The VAS score at the first, second and fourth week after treatment of the observation group were significantly decreases than that of the control group （P 〈 0.05）. Total pain relief rate at fourth week of patients the observation group was 84.4% , significantly higher than that of the control group 35.6% （P 〈 0.05）. The adverse reactions of the observation group mainly included dizziness, thirst, blurred vision, which could be quickly relieved after symptomatic treatment. Conclusion Amitriptyline in treatment of central pain after stroke has a significant curativeeffect and better tolerability.