右美托咪定复合复方倍他米松神经根阻滞联合牵引治疗神经根型颈椎病的效果

Effect of nerve root block by injecting dexmedetomidine combined with compound betamethasone injection together with cervical traction on cervical spondylotic radicular disease

目的评价右美托咪定复合复方倍他米松神经根阻滞联合牵引治疗神经根型颈椎病的效果。方法选取神经根型颈椎病患者100例,随机分成A组和B组,各50例。2组患者均采用超声引导及神经电刺激复制疼痛区域,定位病变神经根。镇痛液配方:2%利多卡因1 mL+复方倍他米松0.5 mL+生理盐水至10 mL,行神经根阻滞注射,每神经根5 mL。其中A组在镇痛液中加入右美托咪定0.2μg·kg-1。所有患者均每周注射1次,最多注射4次。2组均行颈椎间歇牵引治疗,每日1次(NRS评分<3分,停止治疗)。在术后各时点计算显著有效率,同时记录头晕、恶心和低血压等不良反应的例数。结果 A组治疗后7、30、60和90 d各时点显著有效率分别为70.83%、81.25%、89.58%和93.75%,显著优于对照组的63.04%、71.73%、80.43%和86.96%,P均<0.05;各时间点NRS评分分别为(3.2±0.83)、(2.8±0.56)、(2.1±0.45)和(1.5±0.56)分,显著低于对照组的(4.3±0.78)、(3.4±0.65)、(3.1±0.55)和(2.3±0.65)分,P均<0.05;接受第2~4次治疗的患者人数依次为28、12、3人,低于对照组的33、20、8人,P均<0.05。结论右美托咪定复合复方倍他米松神经根阻滞联合牵引治疗神经根型颈椎病,能提高患者的显著有效率及减少治疗次数,降低NRS评分,临床使用安全。

AIM To evaluate the effect of nerve root block by injecting dexmedetomidine combined with compound betamethasone injection together with cervical traction on cervical spondylotic radiculopathy. METH-ODS A total of 100 patients with cervical spondylotic radiculopathy were randomly divided into group A and group B, with 50 patients in each group. The pain lesions of nerve root were located by ultrasound guidance and nerve electrical stimulation in 2 groups. The formula of analgesic liquid: 2% lidocaine 1 mL + compound betamethasone injection 0. 5 mL + physiological saline to 10 mL. Each per nerve root was injected with 5 mL nerve root block injection. Group A was added 0.2μg.kg^-1 dexmedetomidine to the analgesic solution. All patients were injected once a week, with a maximum of 4 times of injections. The 2 groups were treated with intermittent traction of cervi-al vertebrae once a day, and the treatment was stopped if NRS( numerial rating scale) score <3. The significant efficiency at each time point was calculated after operation, and frequencies of adverse drug reactions such as dizziness, nausea and hypotension ect, was recorded. RESULTS The effective rates on 7 d, 30 d, 60 d and 90 d were significantly higher in the group A (70. 83%,81. 25%,89. 58% and 93. 75%) than in the group B (63. 04%,71.73%,80. 43%,86. 96%),P < 0. 05. NRS on 7 d, 30 d, 60 d and 90 d were significantly higher in the group A (3.2 ±0.83,2.8 ± 0. 56 ,2.1±0. 45 and 1.5 ±0.56) than in the group B(4. 3 ± 0. 78 ,3.4 ± 0. 65 , 3. 1 ±0. 55 and 2. 3 ±0.65),P <0. 05. The number of patients receiving the second to fourth in the group A (28, 12,3) was significantly less than that in the group B(33,20,8),P < 0. 05. CONCLUSION Nerve root block by injecting dexmedetomidine combined with compound betamethasone injection together with cervical traction is a more effective therapeutic strategy in treating cervical spondylotic radiculopathy. It can significantly improve the therapeutic effect of cervical spondylotic radicular disease, improve the effective rate within 3 months and reduce the number of treatments, and reduce the NRS score.