下腔静脉滤器植入术后出现腰痛的原因分析及治疗效果

Reason analysis and treatment of postoperative lumbar pain after vena cava filter placement

目的探讨下腔静脉滤器植入术患者不同类型滤器植入后出现腰痛的原因及其临床治疗效果。方法回顾性分析2002年1月至2018年6月河北医科大学第三医院339例下腔静脉滤器植入患者的临床资料,根据植入滤器的类型,将患者分为永久滤器组(153例)及回收滤器组(186例)。滤器植入术后患者均行下腔静脉造影,根据下腔静脉造影异常与否,永久滤器组/回收滤器组又各分为2个亚组(共4个亚组):(1)下腔静脉造影异常组(永久异常亚组,28例);(2)下腔静脉造影正常组(永久正常亚组,125例)/(1)下腔静脉造影异常组(回收异常亚组,46例);(2)下腔静脉造影正常组(回收正常亚组,140例)。观察并记录各组及亚组患者腰痛发生率、腰痛程度,下腔静脉造影异常情况;并分析比较两组患者腰痛程度及治疗效果。结果(1)腰痛发生率:与永久滤器组比较,回收滤器组腰痛发生率更高,两组比较差异有统计学意义(10.22%比2.61%,P<0.05)。与永久正常亚组比较,永久异常亚组腰痛发生率更高,两组比较差异有统计学意义(10.71%比0.80%,P<0.05);与回收正常亚组比较,回收异常亚组腰痛发生率更高,两组比较差异有统计学意义(34.78%比2.14%,P<0.05);与永久异常亚组比较,回收异常亚组腰痛发生率更高,两组比较差异有统计学意义(34.78%比10.71%,P<0.05)。(2)腰痛程度及治疗结果:永久滤器组4例出现腰痛,均为Ⅰ度,疼痛自行缓解。回收滤器组19例患者出现腰痛:15例为Ⅰ度,其中13例疼痛自行缓解,2例需口服镇痛药缓解;3例为Ⅱ度,使用注射镇痛药后2例缓解,1例滤器取出后缓解;1例为Ⅲ度,使用注射镇痛药至滤器回收后缓解。结论下腔静脉滤器体内植入术后引起腰痛的原因与滤器损伤血管壁有关,不同结构滤器对血管壁损伤不同,腰痛程度以Ⅰ度为主,大多可耐受并自行缓解,不耐受及不缓解者镇痛治疗效果较好。

Objective To investigate the causes of low back pain after implantation of inferior vena cava (IVC) filter and summarize the clinical therapeutic effect. Methods The clinical data of 339 patients with IVC filter implantation in the third Hospital of Hebei Medical University were analyzed retrospectively. According to the types of implanted filters, the patients were divided into permanent filter group (153 cases) and recovery filter group (186 cases). All the patients underwent IVC angiography after filter implantation. According to the abnormal IVC, both the permanent filter group and the recovery filter group were divided into two subgroups:(1) abnormal IVC group (28 cases);(2) normal IVC group (permanent normal subgroup, 125 cases);(3)abnormal IVC group (recovery subgroup, 46 cases);(4) normal IVC group (140 cases). The items of the incidence of low back pain, the degree of low back pain and the abnormal condition of ICV angiography in each groups and subgroups were observed and recorded, as well as the degree of low back pain and the therapeutic effect between the two groups were analyzed and compared. Result (1) Incidence of low back pain: The incidence of low back pain in the recovery filter group was higher than that in the permanent filter group with the difference was statistically significant (10.22% vs 2.61%, P<0.05). The incidence of low back pain in the permanent abnormal subgroup was higher than that in the permanent normal subgroup (10.71% vs 0.80, P<0.05). For the incidence of low back pain, the abnormal recovery subgroup was higher than that in the normal recovery subgroup (34.78% vs 2.14 P<0.05), and the abnormal recovery subgroup was higher than that in the permanent abnormal subgroup (34.78% vs 2.14%, P<0.05). The incidence of low back pain in the abnormal recovery subgroup was higher than that in the permanent abnormal subgroup (34.78% vs 10.71%, P<0.05).(2)The degree of low back pain in the permanent filter group was higher than that in the control group(P <0.05). In the recovery filter group, there were 19 cases with low back pain: 15 cases were grade Ⅰ, in which 13 cases were relieved spontaneously, and the remaining 2 cases were relieved by oral analgesics;3 cases were Ⅱ degree, in which 2 cases were relieved after injection of analgesics, and the other case was relieved after removal of filter;One case was degree Ⅲ, who was relieved by injection of analgesics until the filter was removed. Conclusion The reason of low back pain caused by implantation of inferior vena cava filter is related to the injury of vessel wall by the filter. Moreover, the degree of lumbago is mainly in degree I, most of which can be tolerated and self-relieved, or else analgesics can be used.