创伤性脊髓损伤患者神经病理性疼痛的影响因素及临床特点：回顾性研究

关键词：神经病理性疼痛  脊髓损伤  影响因素  临床特点

Keywords:neuropathic pain  spinal cord injury  influencing factors  clinical characteristics

摘要：

      摘要 目的：分析脊髓损伤（spinal cord injury，SCI）患者神经病理性疼痛（neuropathic pain，NPP）的影响因素及临床特点。 方法：对2018年10月—2019年6月从西南医科大学附属医院康复科和四川省绵竹市人民医院康复科出院的SCI患者，进行国际脊髓损伤疼痛数据集调查并分析。 结果：共纳入96例SCI患者，54.2%（52/96）患者出现NPP。多因素Logistic回归分析，性别、年龄、ASIA分级、距离受伤的时间、伤害感受性疼痛与患者是否出现NPP有关（P<0.05）。其中，影响因素前3位分别是伤害感受性疼痛、性别和距离损伤的时间。52位NPP患者中，82.7%（43/52）合并有伤害感受性疼痛。NPP患者平均NRS评分为6.4±2.0，61.5%（32/52）患者1周中每天都会出现疼痛，30.8%（16/52）患者疼痛为持续性，55.8%（29/52）患者疼痛最明显的时间不可预测，疼痛对患者日常生活、活动、情绪、睡眠等产生中度以上的影响及干扰。59.6%（31/52）患者未接受疼痛相关的任何治疗。 结论：伤害感受性疼痛、性别、损伤时间、年龄、ASIA分级与SCI患者是否发生NPP有关。患者平均疼痛强度为中重度，大部分患者每天都会经历疼痛，疼痛最明显的时间不可预测，约1/3患者疼痛为持续性，NPP产生的干扰及影响为中重度。大部分SCI患者未接受规范的NPP相关的治疗。

Abstract:

      Abstract Objective： To analyze the influence factors and clinical characteristics of neuropathic pain(NPP) in patients with spinal cord injury(SCI). Method： A total of 96 patients with SCI discharged from the departments of rehabilitation of the Affiliated Hospital of Southwest Medical University and the Mianzhu People's Hospital of Sichuan Province from October 2018 to June 2019 were investigated using the international spinal cord injury pain data set. Result： A total of 96 patients with SCI were included， 54.2% (52/96) patients had NPP. Multivariate logistic regression analysis suggested that gender， age， ASIA classification， duration of injury， and nociceptive pain were related to whether the patient had neuropathic pain (P<0.05). Among them， the top three influencing factors were nociceptive pain， gender and duration of injury. Of the 52 patients with NPP， 82.7% (43/52) had nociceptive pain. The average NRS of patients with NPP was 6.4±2.0. 61.5%(32/52) patients experienced pain every day for one week， 30.8%(16/52) of the patient had persistent pain， the time of the most severe pain couldn’t be predicted in 55.8%(29/52) of the patients. NPP had moderate to severe negative interference on patients' activities of daily living， emotions， sleep， etc. 59.6% (31/52) did not receive any treatment. Conclusion： Nociceptive pain， gender， duration of injury， age， and ASIA classification were related to whether NPP occurs in SCI patients， the average pain intensity was moderate to severe， and most patients had persistent pain. The interference effects of NPP were moderate to severe. Most of the patients did not receive standard NPP-related treatment.