生命体征的变化能否用于预测腰椎小关节阻滞和射频去神经术的反应？一项前瞻性相关性研究。

Can changes in vital signs be used to predict the response to lumbar facet blocks and radiofrequency denervation? A prospective, correlational study.

作者信息

Cohen Steven P, Atanelov Levan, Rammasubu Chitra, Amasha Raimy, Kurihara Connie, Verdun Aubrey, Duarte Shirley S, Stambaugh Terry

机构信息

From the Departments of *Anesthesiology & Critical Care Medicine and †Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore; and ‡Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD; and §VFA-106, Naval Air Station Oceana, Virginia Beach, VA.

出版信息

Reg Anesth Pain Med. 2014 Jul-Aug;39(4):333-40. doi: 10.1097/AAP.0000000000000105.

DOI:10.1097/AAP.0000000000000105

PMID:24918331

Abstract

BACKGROUND

Facet joint radiofrequency (RF) ablation is characterized by a high failure rate, which is partly due to the fact that pain relief after diagnostic blocks is inherently subjective. An area that has yet to be explored is whether more objective measures, such as changes in vital signs after blocks, might be used to predict treatment outcomes.

METHODS

A multicenter, prospective study was performed in 223 patients who underwent diagnostic lumbar medial branch blocks, of whom 87 proceeded to RF denervation. Blood pressure (BP), heart rate (HR), and pain scores were recorded preblock and 20 minutes postblock. A positive vital sign response was designated as a decrease of less than 7.5 units in BP or HR, and a positive facet block as pain relief of 50% or greater based on 6-hour pain diary scores.

RESULTS

Overall, 125 subjects (56.1%; 95% confidence interval, 49.3%-62.6%) experienced a positive facet block, and 71 had 3-month follow-up information after denervation. Correlations between changes in NRS scores and HR (r = -0.01, P = 0.893), systolic BP (r = 0.05, P = 0.47), diastolic BP (DBP) (r = 0.08, P = 0.22), and mean arterial pressure (r = 0.08, P = 0.21) were weak and nonsignificant. No associations were found between facet block results and any vital sign. Six (85.7%) of 7 patients who experienced a decrease in DBP of greater than 7.5 mm Hg after facet block had a positive RF denervation outcome at 3 months, compared with 43.8% who did not (odds ratio, 7.52; 95% confidence interval, 0.84-363.8; P = 0.049). A classification tree based on significant decrease in DBP, pain duration, and baseline NRS pain score showed a 76.7% (range, 65.8%-86.3%) accuracy rate.

CONCLUSIONS

Although a decrease in DBP of more than 7.5 mm Hg had 97.3% specificity and 85.7% positive predictive value for predicting positive RF ablation outcomes, the low negative predictive value (56.3%) precludes its use as a solitary screening tool. An algorithm based on age, baseline NRS pain score, and a significant decrease in DBP was able to predict 76.7% (range, 65.8%-86.3%) of RF denervation outcomes.

摘要

背景

小关节射频消融术的特点是失败率高，部分原因是诊断性阻滞术后的疼痛缓解本质上是主观的。一个尚未探索的领域是，是否可以使用更客观的指标，如阻滞后生命体征的变化，来预测治疗结果。

方法

对223例行诊断性腰内侧支阻滞的患者进行了一项多中心前瞻性研究，其中87例接受了射频去神经术。在阻滞前和阻滞后20分钟记录血压（BP）、心率（HR）和疼痛评分。生命体征阳性反应定义为BP或HR下降小于7.5个单位，小关节阻滞阳性定义为根据6小时疼痛日记评分疼痛缓解50%或更多。

结果

总体而言，125名受试者（56.1%；95%置信区间，49.3%-62.6%）经历了阳性小关节阻滞，71名患者在去神经术后有3个月的随访信息。数字疼痛评分量表（NRS）评分变化与HR（r = -0.01，P = 0.893）、收缩压（r = 0.05，P = 0.47）、舒张压（DBP）（r = 0.08，P = 0.22）和平均动脉压（r = 0.08，P = 0.21）之间的相关性较弱且无统计学意义。未发现小关节阻滞结果与任何生命体征之间存在关联。7例小关节阻滞后DBP下降大于7.5 mmHg的患者中有6例（85.7%）在3个月时射频去神经术结果为阳性，而未下降的患者中这一比例为43.8%（优势比，7.52；95%置信区间，0.84-363.8；P = 0.049）。基于DBP显著下降、疼痛持续时间和基线NRS疼痛评分的分类树显示准确率为76.7%（范围，65.8%-86.3%）。