目的 探讨超声引导椎旁神经阻滞（ultrasound-guided paravertebral block,UG-PVB）对高海拔地区腰椎间盘突出症（lumbar disc herniation,LDH）的临床疗效及对炎症因子前列腺素E2（prostaglandin E2,PGE2）、5-羟色胺（5-hydroxytryptamine,5-HT）、皮质醇（cortisol,Cor）的调控作用。方法 纳入西藏米林县某医院收治的LDH患者120例,采用随机数字表法分为实验组（n=60）和对照组（n=60）。对照组给予常规药物治疗,实验组在此基础上接受超声引导下椎旁神经阻滞治疗。两组均于治疗前后分别检测血清PGE2、5-HT、Cor水平,并评估视觉模拟评分（visual analog scale,VAS）、JOA（Japanese orthopaedic association score,JOA）评分和Oswestry功能障碍指数（Oswestry disability index,ODI）。结果 UG-PVB组治疗后VAS评分（3.1±1.2 vs 4.7±1.3）、ODI（27.3±5.9 vs 35.9±6.1）显著低于对照组（P<0.001）,JOA评分（22.6±3.5 vs 17.8±3.2）更高;炎症因子降幅（ΔPGE2=145.5±68.2 vs 87.3±60.6,Δ5-HT=78.5±42.0 vs 39.6±31.4,ΔCor=144.1±58.9 vs -77.4±56.9）实验组显著低于对照组（P<0.001）。多元回归显示PGE2、5-HT变化与VAS改善独立相关（β=-0.42,-0.38;P<0.05）。结论 UG-PVB可有效缓解高海拔LDH疼痛,其机制可能与抑制PGE2/5-HT炎症通路相关。
Abstract
Objective To investigate the clinical efficacy of ultrasound-guided paravertebral block (UG-PVB) and its regulatory effects on inflammatory factors, including Prostaglandin E2(PGE2), 5-Hydroxytryptamine (5-HT), and Cortisol (Cor), in patients with Lumbar Disc Herniation (LDH) in high-altitude regions. Methods A total of 120 patients with LDH admitted to a hospital in Milin County, Tibet, were enrolled and randomly assigned into an experimental group (n=60) and a control group (n=60) using a random number table. The control group received conventional pharmacological treatment, while the experimental group received additional UG-PVB therapy. Blood levels of PGE2, 5-HT, and Cor were measured before and after treatment in both groups. Visual Analog Scale (VAS), Japanese Orthopaedic Association (JOA) score, and Oswestry Disability Index (ODI) were also evaluated. Results After treatment, the experimental group showed significantly lower VAS scores (3.1±1.2 vs 4.7±1.3) and ODI scores (27.3±5.9 vs 35.9±6.1), and higher JOA scores (22.6±3.5 vs 17.8±3.2) compared to the control group (P<0.001). Reductions in inflammatory markers were more pronounced in the experimental group (ΔPGE2=145.5±68.2 vs 87.3±60.6; Δ5-HT=78.5±42.0 vs 39.6±31.4; ΔCor=144.1±58.9 vs -77.4±56.9, P<0.001). Multiple regression analysis indicated that changes in PGE2 and 5-HT were independently associated with VAS improvement (β=-0.42 and -0.38, respectively; P<0.05). Conclusion UG-PVB is effective in relieving pain caused by LDH in high-altitude environments, potentially through suppression of the PGE2/5-HT-mediated inflammatory pathway.
关键词
高海拔地区 /
腰椎间盘突出症 /
超声介入 /
椎旁神经阻滞 /
炎症因子
Key words
high-altitude region /
lumbar disc herniation /
ultrasound-guided intervention /
paravertebral block /
inflammatory markers
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基金
2022年珠海市社会发展领域科技计划项目“西藏米林高寒地区超声介入微创治疗腰椎间盘突出症的疗效研究及PGE2、5-HT、缓激肽、Cor等因子的表达关系”（2220004000057）
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