Kim Jeayoun, Park Hue Jung, Sim Woo Seog, Lee Seungwon, Kim Keoungah, Kim Woo Jin, Lee Jin Young
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul 06351, Korea.
Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
J Clin Med. 2021 Jan 12;10(2):240. doi: 10.3390/jcm10020240.
The mechanism of low back and leg pain involves mixed neuropathic and nociceptive components. Spinal neuropathic pain is related to increased levels of inflammatory cytokines and disrupted and increased permeability of the blood-spinal cord barrier, originally composed of tight junctions of capillary endothelial cells surrounded by lamina. The phase angle (PA) estimates cell membrane integrity using bioelectrical impedance analysis. We evaluated the predictive value of the PA for analgesic efficacy in lumbosacral transforaminal block. We retrospectively collected data from 120 patients receiving transforaminal blocks for lumbosacral radicular pain and assessed the PA before and 5 min following the block. Responders (group R) and non-responders (group N) were defined by ≥50% and <50% pain reduction, respectively, on a numerical rating scale, 30 min following the block; clinical data and the PA were compared. Among the 109 included patients, 50 (45.9%) and 59 (54.1%) had ≥50% and <50% pain reduction, respectively. In group N, the PA change ratio showed 88.1% specificity, 32.0% sensitivity, and 62.4% accuracy; a ratio of <0.087 at 5 min following the block predicted non-response. A PA change ratio of <0.087 at 5 min following lumbar transforaminal blocks predicted non-responders with high specificity.
腰腿痛的机制涉及混合性神经病理性和伤害性成分。脊髓神经病理性疼痛与炎症细胞因子水平升高以及血脊髓屏障的破坏和通透性增加有关，血脊髓屏障最初由被薄层包围的毛细血管内皮细胞紧密连接组成。相位角（PA）使用生物电阻抗分析来评估细胞膜完整性。我们评估了PA对腰骶部椎间孔阻滞镇痛效果的预测价值。我们回顾性收集了120例因腰骶部神经根性疼痛接受椎间孔阻滞的患者的数据，并在阻滞前和阻滞后5分钟评估PA。根据阻滞后30分钟数字评分量表上疼痛减轻≥50%和<50%分别定义为反应者（R组）和无反应者（N组）；比较临床数据和PA。在纳入的109例患者中，分别有50例（45.9%）和59例（54.1%）疼痛减轻≥50%和<50%。在N组中，PA变化率显示特异性为88.1%，敏感性为32.0%，准确性为62.4%；阻滞后5分钟时<0.087的比率预测无反应。腰骶部椎间孔阻滞后5分钟时PA变化率<0.087预测无反应者具有较高的特异性。
