复杂性区域疼痛综合征(CRPS)Complex Regional Pain Syndrome.pptVIP

复杂性区域疼痛综合征(CRPS)Complex Regional Pain Syndrome 福建省立医院疼痛科 Department of Analgesia, Fujian Provincal Hospital 傅少雄 2010-10-10 CASE REPORT 患者女性，42岁，以“进行性双下肢麻木、疼痛7个月”为主诉入院。 7个月前行“双足底鸡眼冷冻切除术”后开始出现双下肢麻木感，由双足底逐渐向头端蔓延，6个月前麻木感蔓延至臀部并开始出现持续性针刺样pricking pain或烧灼样疼痛，伴有蚁行感formication、双下肢乏力、双足冰凉感、水肿、臀部多汗等。疼痛较剧，影响睡眠，VAS评分约7-9分。 CASE REPORT 就诊史：多次求诊当地医院，予以止痛等治疗无明显好转。 既往史：患有“2型糖尿病”5年，最高血糖glucose达14.6mmol/l，平素服用中药traditional Chinese medicine控制，偶监测血糖约7.0mmol/l。 辅助检查：胸椎thoracic vertebrae、腰椎MRI（2010.07.09 当地医院）示：无明显异常。 CASE REPORT 入院查体：消瘦外貌，痛苦面容，心、肺、腹查体无明显异常。 专科查体：胸椎、腰椎棘突、棘突间隙、椎旁无压痛、叩击痛，腰椎活动度正常，双下肢肌力3级，双下肢肌张力略高，双侧膝腱反射减弱、双侧足跟腱反射减弱，脐以下触觉减弱，感觉增强，痛觉超敏allodynia、痛觉过敏hyperalgia，皮温35.9°（上肢36.8°）病理征阴性。 CASE REPORT 入院后检查：空腹血糖：10mmol/l，余常规检查无明显异常。 Diagnostic Criteria诊断标准 Diagnostic Criteria诊断标准 Diagnostic Criteria诊断标准 Diagnostic Criteria诊断标准 CRPS II (causalgia) : 1.The presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve 2.Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of pain Diagnostic Criteria诊断标准 CRPS II (causalgia) : 3.The diagnosis is excluded by the existence of any condition that would otherwise account for the degree of pain and dysfunction. 少了I型的第1项 The central difference between Type I and Type II is that, Type II occurs following a known peripheral nerve injury, whereas Type I occurs in the absence of any known nerve injury. 与交感神经的相关性 Pain that can be abolished or greatly reduced by sympathetic blockade (for example, a stellate ganglion block) is called sympathetically maintained pain. Pain that is not affected by sympathetic blockade is called sympathetically independent pain. Angry backfiring c-nociceptor syndrome 与交感神经的相关性 Sympathetically maintained pian, SMP 交感神经维持性疼痛 Sympathetically independent pian,SIP 交感神经无关性疼痛 Angry backfiring c-nociceptor syndrome,ABC ABC综合征 Stage 分期 Stage I (acute stage) :primarily by pain/