创伤性神经痛综合征患者的诊断、治疗和康复特点

S. Kolomentsev, I. Litvinenko, Nikolay V. Tsygan, Al'bert R. Bulatov, Alexey I. Gayvoronsky, Anna V. Kolomentseva, Natalia Y. Polushina, A. V. Ryabtsev, Vladimir A. Panov, E. I. Shermatyuk, Peter A. Polezhaev, Anna A. Kirpichenko, Marina S. Yaroslavtseva
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摘要

背景:现有的国际和国家关于神经性疼痛综合征治疗的临床建议主要基于对非创伤性神经性疼痛患者的护理经验。对敌对行动期间受伤造成神经系统损伤的神经性疼痛综合征患者的诊断、治疗和护理方法可能与躯体疾病患者不同。目的:系统化外伤性神经性疼痛综合征患者的医疗护理特点,改进治疗方法。材料与方法:总结军医神经疾病门诊及科室工作人员2022-2023年积累的外周神经系统外伤性病变伤员(含幻痛综合征患者)救治实践经验。结果:系统梳理了某专科医疗机构创伤性神经性疼痛综合征患者的住院路线、诊断、治疗和医疗护理组织特点。在治疗病人的实际方面,由于在敌对行动中收到的伤口神经性疼痛,涉及预约药物(包括麻醉性镇痛药),区域麻醉和神经外科护理的提供强调。另一个重点是评估神经性疼痛综合征伤员的精神状态和睡眠质量的重要性,药物矫正识别障碍的特征。根据评估神经性疼痛综合征严重程度的结果,使用每日疼痛日记提出了治疗患者的实用建议。结论:创伤性神经性疼痛综合征伤员的治疗和诊断方法存在差异,不同专科医生(神经科医生、外科医生、创伤科医生、神经外科医生、精神科医生)在治疗早期进行跨学科互动的重要性表明,有必要为武装冲突受害者神经性疼痛的治疗制定单独的建议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Features of diagnosis, treatment and curation of patients with neuropathic pain syndrome of traumatic genesis
BACKGROUND: The existing international and national clinical recommendations for the treatment of neuropathic pain syndrome are based mainly on the experience of providing care to patients with non-traumatic genesis of neuropathic pain. Approaches to the diagnosis, treatment and curation patients with neuropathic pain syndrome due damage of the nervous system as a result of wounds received during hostilities may differ from those in patients with somatic diseases. AIM: To systematize the features of medical care and improve the methodological approach of curation patients with traumatic neuropathic pain syndrome. MATERIALS AND METHODS: The practical experience of providing assistance to the wounded with traumatic lesions of the peripheral nervous system (including patients with phantom pain syndrome) accumulated by the staff of the Department and the Clinic of Nervous Diseases Military Medical Academy for 2022–2023 is summarized. RESULTS: The features of inpatient routing, diagnosis, treatment and organization of medical care for patients with traumatic neuropathic pain syndrome at the stage of a specialized medical institution are systematized. The practical aspects of the curation patients with neuropathic pain due to wounds received during hostilities, related to the appointment of medications (including narcotic analgesics), regional anesthesia and the provision of neurosurgical care are highlighted. A separate emphasis is placed on the importance of assessing the mental state and quality of sleep of the wounded with neuropathic pain syndrome, the features of drug correction identified disorders. Practical recommendations for the treatment of patients based on the results of assessing the severity neuropathic pain syndrome using a daily graphic pain diary are presented. CONCLUSION: The revealed differences in therapeutic and diagnostic approaches in providing medical care to the wounded with traumatic neuropathic pain syndrome, the importance of interdisciplinary interaction different specialties doctors (neurologists, surgeons, traumatologists, neurosurgeons, psychiatrists) at the early stages of treatment indicate the need to develop separate recommendations for the treatment of neuropathic pain in victims of armed conflicts.
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