探讨高渗盐水浓度在硬膜外粘连松解术中安全性和有效性:回顾性研究
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A Retrospective Study to Evaluate the Effect of Concentration of Hypertonic Saline on Efficacy and Safety of Epidural Adhesiolysis
背景与目的
经皮硬膜外粘连松解术（PEA）是一种微创手术，是治疗下腰部痛和/或下肢疼痛以及保守治疗无效的硬膜外间隙粘连或者瘢痕形成的手段。高渗盐水的最佳浓度可能是影响PEA安全性和有效性的一个重要因素。我们评价了2种高渗盐水浓度（5%和10%）在腰部PEA中有效性和安全性的差异。
方 法
纳入2009年1月和2014年6月之间在韩国两大教学机构拟接受腰部PEA手术的患者，根据生理盐水渗透压随机分配到5%或10%组。主要指标：评价两组患者下背部和腿部从术前到术后6个月期间的11点数字评分量表（NRS）得分相对于基础值的改变值之间的差异。次要指标：额外硬膜外注射次数、病人对PEA的满意程度以及PEA术后6个月内出现的并发症。
结 果
本研究共纳入543例患者（5%组：333例，10%组：210例）。与基线相比，PEA后两组NRS疼痛评分均显著降低；然而，除了注射相关的疼痛，10%组相比5%组疼痛得分更高（P =0.041），其他指标在PEA术后的6个月内的任何时间点两组之间均没有显著差异。调整协变量后使用多变量线性回归分析，包括额外硬膜外注射的次数等，仍然没有发现患者在6个月的随访疼痛NRS评分减少在两组之间存在差异。3例患者出现与PEA相关的短暂性不良反应（10%组：2例，5%组：1例）。
结 论
在PEA中，5%高渗盐水与10%高渗盐水相比在6个月随访中显示出类似的阳性结果，但其发生输注相关疼痛的概率较低。这一结果表明，5%高渗盐水输注可作为10%高渗盐水在腰部PEA中的替代品。需要进一步的前瞻性随机研究来更好地了解不同浓度高渗盐水对PEA的影响。
原始文献摘要
Choi, E.J., et al., A Retrospective Study to Evaluate the Effect of Concentration of Hypertonic Saline on Efficacy and Safety of Epidural Adhesiolysis. Anesth Analg, 2017. 124(6):2021-2029.
BACKGROUND AND OBJECTIVES:
Percutaneous epidural adhesiolysis (PEA) is a minimally invasive procedure that is performed to relieve low back and/or lower limb pain secondary to adhesions or scarring in the epidural space that is refractory to conservative treatment. The optimal concentration of hypertonic saline might be an important factor in the safety and efficacy of PEA. We evaluated differences in the efficacy and safety of 2 concentrations of hypertonic saline (5% and 10%) used in lumbar PEA at our institutions in a retrospective study.
METHODS:
Patients who received lumbar PEA between January 2009 and June 2014 at either of 2 large civilian teaching institutions in South Korea were assigned to the 5% or 10% groups according to the osmolality of saline. The primary outcome of this study was the difference in change in the 11-point numerical rating scale (NRS) scores of low back and leg pain from baseline to 6 months after PEA between patients in the 2 groups. The number of additional epidural injections, patients’ satisfaction with PEA, and any complications that occurred within 6 months after PEA were reviewed.
RESULTS:
This study included 543 patients (5% group, 333; 10% group, 210). Post-PEA NRS pain scores were significantly lower compared with those at baseline in both groups; however, there were no significant differences between the 2 groups at 6 months or any time point after PEA with regard to any of the clinical characteristics, except infusion-related pain, which exhibited borderline significance for greater scores in the 10% group compared with those in the 5% group (P = .041). Multivariable linear regression analysis with adjustments for covariates, including the number of additional epidural injections, revealed no significant association between patient group and the decrease in NRS pain scores at 6 months of follow-up. Transient adverse events related to PEA were recorded in 3 patients (10% group, 2; 5% group, 1).
CONCLUSION:
In PEA, 5% hypertonic saline exhibited similar positive outcomes after 6 months of follow-up as 10% hypertonic saline, with less infusion-related pain. This result suggests that infusion of 5% hypertonic saline may be considered as an alternative to 10% hypertonic saline in lumbar PEA. Further prospective randomized studies are required to better appreciate the outcome with regard to the use of different concentrations of hypertonic saline for PEA.
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