糖皮质激素在疼痛微创介入治疗中的应用(中国专家共识)解读:糖皮质激素在硬膜外腔注射的风险及其防控对策

摘要

硬膜外腔糖皮质激素注射(ESI)是将局麻药或/和糖皮质激素(GCS)等注射入病灶等相应部位的硬膜外腔,抑制局部炎性反应、阻断恶性神经传导,从而缓解、消除疼痛.虽然ESI技术历史悠久、受众面广,但ESI可引起严重神经系统不良事件,甚至致死,而备受关注.《糖皮质激素在疼痛微创介入治疗中的应用——中国专家共识》也建议ESI应由经过专业培训的专科医师进行操作.本文结合文献,就ESI操作时,与GCS相关严重不良反应及其防治措施展开解读.%Epidural steroid injection (ESI), the injection of local anesthetics or glucocorticoids (GCS) into the epidural space, is the most commonly performed procedure for the treatment of spinal pain worldwide. The epidural approach is most often used to optimize the local, anti-inflammatory effects of corticosteroid at the nerve root level. An additional warning emphasized that epidural injections of steroids may cause spinal cord infarction, paraplegia, quadriplegia, cortical blindness and stroke, spoken by USA Food and Drug Administration in 2014 for ESI. Application of glucocorticoids in minimally invasive interventional treatment for pain (Chinese expert consensus) also suggested that this procedure should be done by trained physicians. This paper summarized the literatures in order to interpret the Chinese expert consensus about the untoward effects and its prevention during the manipulation of ESI in detail.