乌司他丁联合加巴喷丁及芬太尼对神经病理性疼痛患者的镇痛效果及炎症因子的影响

Effects of ulinastatin combined with gabapentin and fentanyl on analgesic effect and inflammatory factor level in patients with neuropathic pain.

目的探讨乌司他丁联合加巴喷丁及芬太尼治疗神经病理性疼痛(NP)的镇痛效果及对患者炎症因子水平的影响。方法选择中国人民解放军空军军医大学第二附属医院2019年1月至2021年1月收治的200例NP患者为研究对象,采用随机数表法分为对照组和观察组,每组100例。对照组患者给予加巴喷丁及芬太尼治疗,观察组患者在对照组治疗基础上联合乌司他丁治疗,1周为一个疗程,共治疗4周。比较两组患者治疗前后的疼痛数字评分(NRS)、炎症因子[前列腺素E2(PEG2)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)]水平及生活质量量表(QOL)变化,并统计两组患者治疗期间的不良反应发生情况。结果治疗后,两组患者的NRS评分均降低,且观察组为(2.21±0.26)分,明显低于对照组的(3.38±0.47)分,差异均有统计学意义(P<0.05);治疗后,两组患者的PGE2、IL-1β、IL-6水平均降低,且观察组患者的上述各项指标分别为(34.14±4.23)μg/mL、(7.91±1.23)pg/mL、(8.21±1.34)pg/mL,明显低于对照组的(78.91±5.99)μg/mL、(11.39±2.21)pg/mL、(13.41±2.67)pg/mL,差异均有统计学意义(P<0.05);治疗后,两组患者的睡眠、食欲、日常生活、精神状态评分均降低,且观察组患者的上述各项评分分别为(2.31±0.30)分、(2.19±0.21)分、(2.10±0.31)分、(2.51±0.19)分,明显低于对照组的(3.89±0.28)分、(3.98±0.40)分、(3.74±0.51)分、(3.92±0.17)分,差异均有统计学意义(P<0.05);观察组和对照组患者的不良反应发生率分别为8.00%、11.00%,差异无统计学意义(P>0.05)。结论乌司他丁联合巴喷丁及芬太尼治疗NP可有效抑制炎症因子释放,缓解疼痛,改善生活质量,安全性较高,可在临床中推广应用。

Objective To investigate the analgesic effect of ulinastatin combined with gabapentin and fentanyl in the treatment of neuropathic pain(NP)and its effect on the level of inflammatory factors.Methods A total of 200 patients with NP treated in the Second Affiliated Hospital of Air Force Medical University of PLA from January 2019 to January 2021 were selected and divided into a control group and an observation group according to random number table,with 100 patients in each group.The patients in the control group were treated with gabapentin and fentanyl,and the patients in the observation group were treated with ulinastatin on the basis of the treatment in the control group,with one week as a course of treatment,for a total of 4 weeks.The Pain Numerical Rating Scale(NRS)for Pain Intensity,inflammatory factors levels[prostaglandin E2(PEG2),interleukin-6(IL-6),and interleukin-1β(IL-1β)],and quality of life(QOL)scale changes were compared between the two groups before and after treatment,and the adverse reactions of the two groups during treatment were counted.Results After treatment,the NRS score of the two groups decreased,and the score of the observation group was(2.21±0.26)points,which was significantly lower than(3.38±0.47)points of the control group;the differences were statistically significant(P<0.05).After treatment,PGE2,IL-1β,and IL-6 levels in the two groups significantly decreased,and the above indexes in the observation group were(34.14±4.23)μg/mL,(7.91±1.23)pg/mL,and(8.21±1.34)pg/mL,which were significantly lower than(78.91±5.99)μg/mL,(11.39±2.21)pg/mL,and(13.41±2.67)pg/mL in the control group,with statistically significant differences(P<0.05).After treatment,the scores of sleep,appetite,daily life,and mental state of patients in the two groups decreased,and the above scores of patients in the observation group were(2.31±0.30)points,(2.19±0.21)points,(2.10±0.31)points,and(2.51±0.19)points,which were significantly lower than(3.89±0.28)points,(3.98±0.40)points,(3.7±0.51)points,and(3.92±0.17)points in the control group,with statistically significant differences(P<0.05).The incidence of adverse reactions in the observation group and the control group were 8.00%and 11.00%,respectively,with no statistically significant difference(P>0.05).Conclusion Ulinastatin combined with gabapentin and fentanyl in the treatment of NP can effectively inhibit the release of inflammatory factors,relieve pain,and improve the quality of life,which has high safety and can be popularized and applied in clinic.