经颅直流电刺激治疗腰椎融合术后疼痛的疗效观察

The observation of curative effect of transcranial direct current stimulation on the treatment of pain after lumbar fusion operation

目的观察经颅直流电刺激(tDCS)治疗腰椎融合术后疼痛的临床疗效。方法回顾性分析2016年1月—12月天津医院微创脊柱外科接受腰椎融合手术的患者资料。根据术后给予的镇痛策略分为tDCS组和对照组,tDCS组患者给予氟比洛芬酯注射液联合tDCS控制术后疼痛,必要时使用吗啡控制爆发性疼痛;对照组给予氟比洛芬酯联合吗啡镇痛。记录患者术前及术后疼痛视觉模拟评分(VAS)、功能障碍指数评分(ODI)、阿片类药物使用量及治疗相关并发症等指标。结果共纳入42例。tDCS组22例,平均年龄(56.7±10.5)岁;对照组20例,平均年龄(60.3±9.2)岁。2组患者术前VAS、ODI评分差异无统计学意义。2组患者术后24 h及出院时疼痛VAS评分、ODI与同组内术前相比明显改善;与对照组相比,tDCS组患者术后24 h VAS评分(2.0±1.7)、出院时VAS评分(2.1±0.9)以及出院时ODI(20.9±6.5)明显低于对照组(3.3±1.4,2.9±1.3,25.4±5.3),差异有统计学意义。采用tDCS联合阿片类药物控制术后暴发性疼痛,可减少约25%阿片类药物的使用量(P<0.01),而并发症仅为电极粘贴部位的瘙痒、疼痛、灼热及刺痛。结论在腰椎融合术后患者中使用经颅直流电刺激可降低患者疼痛、减少麻醉药物使用、促进患者快速康复,不会增加相关并发症的发生率,具有替代阿片类药物治疗疼痛的潜在可能性。

Objective To observe the clinical efficacy of transcranial direct current stimulation （tDCS） in the treatment of pain after lumbar fusion operation. Methods Patients underwent lumbar fusion surgery in the Department of Minimally Invasive Spine Surgery, Tianjin Hospital from January 2016 to December 2016 were retrospective analyzed. They were divided into tDCS group and control group according to the postoperative analgesic strategies. Patients in tDCS group were given flurbiprofen injection combined with tDCS to control postoperative pain, and morphine was used if necessary. The control group was only given flurbiprofen injection combined with morphine analgesia to manage postoperative pain. The data of preoperative and postoperative pain visual analogue score （VAS）, oswestry disability index （ODI）, opioid analgesics usage and complications before and after operation were recorded. Results Forty-two patients were included in this study. There were 22 patients in tDCS group with the mean age （56.7±10.5） years, and 20 in control group with the mean age （60.3± 9.2） years. There were no significant differences in preoperative VAS and ODI scores between two groups. The VAS and ODI scores at postoperative 24 h and hospital discharge significantly improved in two groups compared with preoperative data. Data of postoperative 24 h VAS score （2.0 ± 1.7）, VAS score （2.1 ± 0.9） and ODI score （20.9 ± 6.5） at hospital discharge were significantly lower in tDCS group than those in control group （3.3 ± 1.4, 2.9 ± 1.3 and 25.4 ± 5.3）. The dosage of opioid medication use in controlling postoperative pain was reduced about 25% in tDCS group （P 〈 0.01）. The complications reported in tDCS group included itching under the electrodes, pain, scorching hot and stinging. Conclusion The use of tDCS after lumbar fusion operation can decrease the pain sensation, reduce the usage of opioids, promote the rehabilitation and with no increasing the incidence of related complications, which has the potential probability to replace opioids for chronic pain.