阿米替林治疗脑卒中后中枢痛的疗效和耐受性分析(1)
[摘要] 目的 观察阿米替林治疗脑卒中后中枢痛的效果和不良反应，分析其耐受性。 方法 入组90例2014年1月～2015年1月在我院治疗的脑卒中患者，所有患者疼痛持续时间均超过3个月，随机分为观察组(n=45)和对照组(n=45)。观察组患者给予阿米替林25mg (2次/d)，对照组患者给予复合维生素B片3片(3次/d)，疗程4周。所有患者治疗前和治疗后3d、1周、2周、4周分别进行视觉模拟评分(VAS)和疼痛缓解度(PAR)测定，比较两组患者治疗前后VAS评分、疼痛缓解总有效率和不良反应耐受情况。 结果 两组患者治疗后第4周VAS评分均较治疗前显著降低(P均<0.05)；观察组患者治疗后1周、2周、4周VAS评分较对照组显著降低(P<0.05)；观察组患者第4周疼痛总缓解率为84.4%，显著高于对照组第4周疼痛总缓解率35.6%(P<0.05)；观察组不良反应主要为头晕、口干和视物模糊，对症治疗后，不良症状均可快速缓解。 结论 阿米替林治疗脑卒中后中枢痛疗效显著，耐受性良好。
[关键词] 阿米替林；脑卒中后中枢痛；疗效；耐受性
, 百拇医药
[中图分类号] R743.3 [文献标识码] B [文章编号] 2095-0616(2015)15-91-04
[Abstract] Objective To observe the curative effect and adverse reactions of amitriptyline in the treatment of central pain after stroke and analyze the tolerability of amitriptyline. Methods 90 patients with central pain after stroke who were admitted to our hospital from January 2014 to January 2015 were selected in this study. The duration of pain of all patients was more than 3 months. These patients were randomly divided into the observation group and the control group with 45 in each. Patients in the observation group were treated with amitriptyline 25 mg for twice a day while patients in the control group were treated with 3 pieces of compound vitamins B tablets for three times a day. The course of treatment was 4 weeks. All patients were received detection of visual analogue scale (VAS) and the pain relief rate (PAR) 3 days， 1， 2， 4 weeks before and after treatment respectively. The VAS score， total effective rate of pain relief and the tolerability of adverse reactions before and after treatment between the two groups were compared. Results VAS scores at the fourth week after treatment of two groups were both significantly lower than that before treatment (P<0.05). The VAS score at the first， second and fourth week after treatment of the observation group were significantly decreases than that of the control group (P<0.05). Total pain relief rate at fourth week of patients the observation group was 84.4%， significantly higher than that of the control group 35.6% (P<0.05). The adverse reactions of the observation group mainly included dizziness， thirst， blurred vision， which could be quickly relieved after symptomatic treatment. Conclusion Amitriptyline in treatment of central pain after stroke has a significant curative effect and better tolerability.
, 百拇医药
[Key words] Amitriptyline； Central pain after stroke； Curative effect； Tolerability
患者卒中后可出现脑卒中后中枢性疼痛(central post-stroke pain，CPSP)，如肌肉骨骼痛、肩痛、痛性痉挛、头痛及脑卒中后中枢性疼痛[1]。CPSP指与缺血性脑梗死灶或出血灶相关的偏侧躯体疼痛或感觉异常，是一种发生于卒中后的慢性中枢性神经病理性疼痛综合征[2]。国外一项研究显示，CPSP的发病率为8%～48%。该病的发生机制目前尚不明确，但因不论给予正常或异常温度或刺激，CPSP患者对其均有不正常反应，表现出反应过度或反应迟钝[3]。抗抑郁药三环类抗抑郁药对于控制CPSP效果较好。目前，该类药物是治疗神经病理性疼痛的一线用药。研究显示，阿米替林可减轻CPSP患者的疼痛程度[4]。本研究通过观察阿米替林治疗脑卒中后中枢痛的效果和不良反应耐受情况，分析其疗效和耐受性。, 百拇医药(陈小燕 黄湘霞 许俏容)
[关键词] 阿米替林；脑卒中后中枢痛；疗效；耐受性
, 百拇医药
[中图分类号] R743.3 [文献标识码] B [文章编号] 2095-0616(2015)15-91-04
[Abstract] Objective To observe the curative effect and adverse reactions of amitriptyline in the treatment of central pain after stroke and analyze the tolerability of amitriptyline. Methods 90 patients with central pain after stroke who were admitted to our hospital from January 2014 to January 2015 were selected in this study. The duration of pain of all patients was more than 3 months. These patients were randomly divided into the observation group and the control group with 45 in each. Patients in the observation group were treated with amitriptyline 25 mg for twice a day while patients in the control group were treated with 3 pieces of compound vitamins B tablets for three times a day. The course of treatment was 4 weeks. All patients were received detection of visual analogue scale (VAS) and the pain relief rate (PAR) 3 days， 1， 2， 4 weeks before and after treatment respectively. The VAS score， total effective rate of pain relief and the tolerability of adverse reactions before and after treatment between the two groups were compared. Results VAS scores at the fourth week after treatment of two groups were both significantly lower than that before treatment (P<0.05). The VAS score at the first， second and fourth week after treatment of the observation group were significantly decreases than that of the control group (P<0.05). Total pain relief rate at fourth week of patients the observation group was 84.4%， significantly higher than that of the control group 35.6% (P<0.05). The adverse reactions of the observation group mainly included dizziness， thirst， blurred vision， which could be quickly relieved after symptomatic treatment. Conclusion Amitriptyline in treatment of central pain after stroke has a significant curative effect and better tolerability.
, 百拇医药
[Key words] Amitriptyline； Central pain after stroke； Curative effect； Tolerability
患者卒中后可出现脑卒中后中枢性疼痛(central post-stroke pain，CPSP)，如肌肉骨骼痛、肩痛、痛性痉挛、头痛及脑卒中后中枢性疼痛[1]。CPSP指与缺血性脑梗死灶或出血灶相关的偏侧躯体疼痛或感觉异常，是一种发生于卒中后的慢性中枢性神经病理性疼痛综合征[2]。国外一项研究显示，CPSP的发病率为8%～48%。该病的发生机制目前尚不明确，但因不论给予正常或异常温度或刺激，CPSP患者对其均有不正常反应，表现出反应过度或反应迟钝[3]。抗抑郁药三环类抗抑郁药对于控制CPSP效果较好。目前，该类药物是治疗神经病理性疼痛的一线用药。研究显示，阿米替林可减轻CPSP患者的疼痛程度[4]。本研究通过观察阿米替林治疗脑卒中后中枢痛的效果和不良反应耐受情况，分析其疗效和耐受性。, 百拇医药(陈小燕 黄湘霞 许俏容)