高压氧联合地塞米松治疗剖宫产椎管内麻醉后脊神经根损伤62例疗效观察

Hyperbaric oxygen combined with dexamethasone in the treatment of spinal nerve root injury after intraspinal anesthesia for caesarean section in 62 cases

目的探讨高压氧(HBO)联合地塞米松治疗剖宫产椎管内麻醉后脊神经根损伤的临床疗效。方法回顾性分析2017年4月至2023年4月解放军总医院第一医学中心麻醉科收集的109例剖宫产椎管内麻醉后脊神经根损伤患者的临床资料。按照治疗方法将109例患者分为联用组(n=62)和对照组(n=47)。2组患者在穿刺或置管过程中出现下肢触电感且不自主收缩等神经刺激症状,均即刻和术毕分别经硬膜外注射地塞米松5 mg治疗。对照组患者术后第2天继续静脉滴注地塞米松10 mg,联用组在对照组治疗的基础上加用HBO治疗。采用视觉模拟评分(VAS)分别对2组患者术后第2、5、8天疼痛、麻木和感觉异常进行评估,并统计临床疗效。采用酶联免疫吸附法测定患者术后第2、5、8天血清白细胞介素(IL)-8、IL-10及肿瘤坏死因子α(TNF-α)水平;采用散射比浊法测定血清高敏C反应蛋白(hs-CRP)水平。采用匹兹堡睡眠质量指数(PSQI)评分法分别对2组患者术后第2、5、8天睡眠质量进行统计。结果联用组术后第8天治疗总有效率(98.4%)明显高于对照组(83.0%),差异有统计学意义(χ^(2)=4.471,P=0.024)。与对照组术后第5、8天比较,联用组相应时点疼痛、麻木及感觉异常评分均明显降低(P<0.05)。与同组术后第2天相比,2组患者术后第5、8天血清TNF-α、hs-CRP、IL-8水平明显降低,IL-10水平明显升高(P<0.01);与同组术后第5天比较,2组患者第8天血清TNF-α、hs-CRP、IL-8水平明显降低,IL-10水平明显升高(P<0.05);与对照组术后第5、8天比较,联用组相应时点血清TNF-α、hs-CRP、IL-8水平明显降低,IL-10水平明显升高(P<0.05)。与对照组术后第5、8天比较,联用组相应时点PSQI评分均明显降低(P<0.05)。结论HBO联合地塞米松治疗剖宫产椎管内麻醉后脊神经根损伤临床疗效显著,能明显降低患者疼痛、麻木及感觉异常评分,改善睡眠质量。

Objective To investigate the clinical efficacy of hyperbaric oxygen(HBO)combined with dexamethasone in the treatment of spinal nerve root injury after intraspinal anesthesia in patients underwent caesarean section.Methods The clinical data of 109 patients with nerve root injury after intraspinal anesthesia during caesarean section in the Anesthesia Department of the First Medical Center of the PLA General Hospital from April 2017 to April 2023 were retrospectively analyzed.According to the treatment method,109 patients were divided into combination group(n=62)and control group(n=47).The patients experienced nerve stimulation symptoms,such as lower limb electric shock and involuntary contraction,and were treated with 5 mg dexamethasone through epidural injection upon occurrence and after surgery,respectively.The patients in the control group received 10 mg of intravenous dexamethasone on the second day after surgery,while the patients in the combination group received HBO treatment based on the treatments for the control group.Two groups of patients were evaluated for pain,numbness,and sensory abnormalities on the 2nd,5th,and 8th day after operation using visual analog scale(VAS),and clinical efficacy was analyzed.Enzyme-linked immunosorbent assay was used to measure the levels of serum interleukin-8(IL-8),interleukin-10(IL-10),and tumor necrosis factor-α(TNF-α)on the 2nd,5th,and 8th day after operation.Serum high-sensitivity C-reactive protein(hs-CRP)levels were measured using nephelometric turbidity method.The Pittsburgh sleep quality index(PSQI)scoring method was used to analyze the sleep quality of the patients in the two groups on the 2nd,5th,and 8th day after operation.Results The total effective rate of the combined group on the 8th day after surgery(98.4%)was significantly higher than that of the control group(83.0%),with a statistical difference(χ^(2)=4.471,P=0.024).Compared with the control group on the 5th and 8th day after surgery,the pain,numbness,and sensory abnormalities scores of the combination group were significantly reduced at the corresponding time points(P<0.05).Within the same group,compared with the serum levels of TNF-α,hs-CRP,and IL-8 on the 2nd day after surgery,those on the 5th and 8th day after surgery in both groups were significantly reduced,while the levels of IL-10 were significantly increased(P<0.01).Within the same group,compared with the levels of serum TNF-αand hs-CRP,and IL-8 on the 5th day after surgery,those on the 8th day in both groups were significantly reduced,while the levels of IL-10 were significantly increased(P<0.05).Compared with the control group on the 5th and 8th day after surgery,the serum levels of TNF-α,hs-CRP,and IL-8 in the combined group were significantly reduced on the 5th and 8th day after surgery,while the levels of IL-10 were significantly increased(P<0.05).Compared with the control group on the 5th and 8th day after surgery,the PSQI scores of the combination group at the corresponding time points were significantly reduced(P<0.05).Conclusion HBO combined with dexamethasone has a significant clinical effect on treating nerve root injury after cesarean section intraspinal anesthesia,which can significantly reduce the pain,numbness,and sensory abnormalities scores,and improve sleep quality.