目的 探討替扎尼定聯(lián)合利多卡因治療腰椎術(shù)后疼痛綜合征的臨床療效。方法 選取2022年5月—2024年5月在鄭州大學(xué)第一附屬醫(yī)院治療的96例腰椎術(shù)后疼痛綜合征患者的臨床資料進(jìn)行回顧性分析，根據(jù)用藥的不同分為對(duì)照組（48例）和治療組（48例）。對(duì)照組推注鹽酸利多卡因注射液，取側(cè)臥位，執(zhí)行硬脊膜外間隙穿刺，持續(xù)泵入0.5%利多卡因，以泵速4.2 mL/h作以鎮(zhèn)痛。在對(duì)照組的基礎(chǔ)上，治療組口服鹽酸替扎尼定片，4 mg/次，2次/d。兩組患者治療10 d。觀察兩組患者臨床療效，比較治療前后兩組患者癥狀及體征好轉(zhuǎn)時(shí)間，Oswestry功能障礙指數(shù)問卷評(píng)分（ODI）和視覺模擬評(píng)分法（VAS）評(píng)分，血清β-內(nèi)啡肽（β-EP）、白細(xì)胞介素-6（IL-6）、前列腺素E₂（PGE₂）和IL-1水平。結(jié)果 治療后，治療組總有效率為95.83%，明顯高于對(duì)照組的總有效率（81.25%，P＜0.05）。治療后，與對(duì)照組比較，治療組腰部疼痛、肢體酸脹、肢體麻木、下肢皮膚感覺異常等情況好轉(zhuǎn)時(shí)間較對(duì)照組明顯縮短（P＜0.05）。治療后，兩組ODI評(píng)分、VAS評(píng)分較治療前明顯降低（P＜0.05），且治療后治療組評(píng)分比對(duì)照組降低更明顯（P＜0.05）。治療后，兩組患者血清β-EP水平明顯升高，而IL-6、PEG2、IL-1水平明顯降低（P＜0.05），且治療組血清炎性因子水平改善更明顯（P＜0.05）。結(jié)論 替扎尼定聯(lián)合利多卡因替治療腰椎術(shù)后疼痛綜合征，能緩解腰椎疼痛的癥狀及體征，并對(duì)腰椎功能障礙有較大的改善，機(jī)體的疼痛介質(zhì)因子降低明顯。

Objective To explore the treatment effect of tizanidine combined with lidocaine in treatment of in lumbar spine surgery. Methods The clinical data of 96 patients with postoperative pain syndrome of lumbar spine treated in the First Affiliated Hospital of Zhengzhou University from May 2022 to May 2024 were selected and analyzed retrospectively. They were divided into control (48 cases) and treatment (48 cases) group based on different treatments. Patients in the control group were iv administered with Lidocaine Hydrochloride Injection, and taken lateral position, performed epidural space puncture, and continuously pumped 0.5% lidocaine at a pump speed of 4.2 mL/h to relieve pain. Patients in the treatment group were po administered with Tizanidine Hydrochloride Tablets on the basis of the control group, 4 mg/time, twice daily. Patients in two groups were treated for 10 d. After treatment, the clinical evaluations were evaluated, the improvement time of symptoms and signs, the scores of ODI and VAS, the levels of β-EP, IL-6, PEG₂ and IL-1 in two groups before and after treatment were compared. Results After treatment, the total effective rate in the treatment group was 95.83%, which was significantly higher than that in the control group (81.25%, P < 0.05). After treatment, compared with the control group, the improvement time for waist pain, limb soreness, limb numbness, and limb skin paraesthesia in the treatment group was significantly shorter than that in the control group (P < 0.05). After treatment, the ODI score and VAS score in two groups were significantly lower than that of before treatment (P < 0.05), and the score in the treatment group were decreased more significantly than that in the control group (P < 0.05). After treatment, serum β-EP levels were significantly increased in two groups, while IL-6, PEG₂, and IL-1 levels were decreased significantly (P < 0.05), and serum inflammatory factor levels improved more significantly in the treatment group (P < 0.05). Conclusion The synergistic treatment of lidocaine hydrochloride and tizanidine can alleviate the symptoms and signs of lumbar pain, and significantly improve the degree of lumbar functional impairment.

R971

河南省醫(yī)學(xué)科技攻關(guān)計(jì)劃項(xiàng)目(LHGJ20190840)