Alnahhas Mhd Firas, Oxentenko Shawn C, Locke G Richard, Hansel Stephanie, Schleck Cathy D, Zinsmeister Alan R, Farrugia Gianrico, Grover Madhusudan
Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Division of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Dig Dis Sci. 2016 Feb;61(2):572-7. doi: 10.1007/s10620-015-3857-8. Epub 2015 Aug 30.
Abdominal wall pain (AWP) is an important cause of chronic abdominal pain. History and physical examination are critical to the diagnosis of AWP. Trigger point injection (TPI) using either a steroid or a local anesthetic or a combination of both is often used to treat AWP.
To determine the efficacy of ultrasound-guided TPI and to determine the predictors of a successful response.
Patients who received ultrasound-guided TPI between July 2010 and June 2011 were surveyed. The primary outcome was determined using the Treatment Efficacy Questionnaire (TEQ). Electronic medical records were reviewed to determine patient, pain and TPI characteristics. Linear regression was used to determine the predictors of a successful response on the TEQ.
Right upper quadrant was the most common site of AWP, and the median pain duration was 12 months. Pain was rated as >8 (1-10 scale) by 57 % and 30 % described it as an ache. Narcotic use was reported in 38 %, and 73 % had a history of at least one abdominal surgery. Forty-four of the 120 (37 %) patients met the criteria for responder on the TEQ. Compared to before treatment, 36 % reported being "significantly better" and 22 % "slightly better." Multiple linear regression analysis showed that higher somatization negatively predicted response. None of the other historical, examination or TPI characteristics were associated with response to the TPI.
TPI can provide significant, long-term symptom relief in a third of patients with chronic abdominal pain attributed to AWP. Somatization was inversely related to the treatment success.
腹壁疼痛（AWP）是慢性腹痛的一个重要原因。病史和体格检查对AWP的诊断至关重要。使用类固醇、局部麻醉剂或两者联合的触发点注射（TPI）常用于治疗AWP。
确定超声引导下TPI的疗效，并确定成功反应的预测因素。
对2010年7月至2011年6月期间接受超声引导下TPI的患者进行调查。主要结局通过治疗效果问卷（TEQ）确定。回顾电子病历以确定患者、疼痛和TPI特征。采用线性回归确定TEQ成功反应的预测因素。
右上腹是AWP最常见的部位，中位疼痛持续时间为12个月。57%的患者疼痛评分为>8（1-10分制），30%的患者将其描述为隐痛。38%的患者报告使用过麻醉剂，73%的患者有至少一次腹部手术史。120例患者中有44例（37%）符合TEQ反应者标准。与治疗前相比，36%的患者报告“明显好转”，22%的患者“稍有好转”。多元线性回归分析显示，较高的躯体化程度对反应有负面预测作用。其他病史、检查或TPI特征均与TPI反应无关。
TPI可为三分之一归因于AWP的慢性腹痛患者提供显著的长期症状缓解。躯体化与治疗成功呈负相关。
