甘露醇在腰椎间盘突出症术后“反跳痛”治疗中的应用

目的：探讨甘露醇注射液在腰椎间盘突出症术后"反跳痛"治疗中的临床疗效。方法：收集2014年3月到2017年3月在我院行椎间盘镜下髓核摘除术的患者共82例,将所有患者随机分为3组,其中对照组27例,甘露醇组30例,地塞米松组25例。术前记录患者下肢痛的视觉模拟评分（VAS评分）,腰椎日本骨科协会评估治疗分数（JOA评分）。术后甘露醇组使用20%甘露醇注射液125 mL静脉滴注,每8小时一次,连用一周。地塞米松组使用20 mg地塞米松磷酸钠注射液加入葡萄糖注射液,3 d后地塞米松减量为10 mg,连用一周。记录术后下肢痛的VAS评分和腰椎JOA评分,以及是否有下肢"反跳痛"及其VAS评分和持续时间。结果：3组患者手术前后VAS评分和JOA评分没有显著性差异（P>0.05）。3组患者术后下肢"反跳痛"的发生率没有显著性差异（P>0.05）。地塞米松可减少术后下肢痛的VAS评分,甘露醇无此效果,差异有显著性差异（P<0.05）。结论：甘露醇不能减少术后下肢"反跳痛"的发生率,疼痛程度和持续时间。

The application of mannitol in the treatment of “rebound tenderness” after lumbar disc herniation surgery

OBJECTIVE To explore the effect of mannitol injection in the treatment of "rebound tenderness" after lumbar disc herniation surgery. METHODS A total of 82 patients who underwent discoscopic nucleus pulposus resection in a hospital from March 2014 to March 2017 were included. All patients were randomly divided into 3 groups, including control group (27 cases), mannitol group (30 cases), and dexamethasone group (25 cases). Pre-operative VAS score and lumbar JOA score of the patients' lower limb pain were recorded. After operation, the mannitol group was treated with 125 mL of 20% mannitol injection by intravenous drip every 8 hours for one week. In the dexamethasone group, 20 mg dexamethasone sodium phosphate injection was added to glucose injection, and the dexamethasone was reduced to 10mg after 3 days, which lasted for one week. The VAS score and the lumbar JOA score of lower limb pain were recorded, as well as the lower limb "rebound tenderness" and its VAS score and duration. RESULTS There was no significant difference in VAS score and JOA score between the three groups (P>0.05). The incidence of postoperative lower limb "rebound tenderness" in the three groups was not statistically significant.(P>0.05). Dexamethasone reduced the VAS score of postoperative lower limb pain, while mannitol had no such effect, and the difference was statistically significant (P<0.05).(P<0.05). CONCLUSION Mannitol does not reduce the incidence, severity and duration of postoperative lower limb rebound tenderness.