目的 探讨替扎尼定联合利多卡因治疗腰椎术后疼痛综合征的临床疗效。方法 选取2022年5月—2024年5月在郑州大学第一附属医院治疗的96例腰椎术后疼痛综合征患者的临床资料进行回顾性分析，根据用药的不同分为对照组（48例）和治疗组（48例）。对照组推注盐酸利多卡因注射液，取侧卧位，执行硬脊膜外间隙穿刺，持续泵入0.5%利多卡因，以泵速4.2 mL/h作以镇痛。在对照组的基础上，治疗组口服盐酸替扎尼定片，4 mg/次，2次/d。两组患者治疗10 d。观察两组患者临床疗效，比较治疗前后两组患者症状及体征好转时间，Oswestry功能障碍指数问卷评分（ODI）和视觉模拟评分法（VAS）评分，血清β-内啡肽（β-EP）、白细胞介素-6（IL-6）、前列腺素E₂（PGE₂）和IL-1水平。结果 治疗后，治疗组总有效率为95.83%，明显高于对照组的总有效率（81.25%，P＜0.05）。治疗后，与对照组比较，治疗组腰部疼痛、肢体酸胀、肢体麻木、下肢皮肤感觉异常等情况好转时间较对照组明显缩短（P＜0.05）。治疗后，两组ODI评分、VAS评分较治疗前明显降低（P＜0.05），且治疗后治疗组评分比对照组降低更明显（P＜0.05）。治疗后，两组患者血清β-EP水平明显升高，而IL-6、PEG2、IL-1水平明显降低（P＜0.05），且治疗组血清炎性因子水平改善更明显（P＜0.05）。结论 替扎尼定联合利多卡因替治疗腰椎术后疼痛综合征，能缓解腰椎疼痛的症状及体征，并对腰椎功能障碍有较大的改善，机体的疼痛介质因子降低明显。

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

河南省医学科技攻关计划项目(LHGJ20190840)