應用維生素C&OH-Bl2和引發點注射治療持續性腹痛的案例報告

Relief of Persistent Abdominal Pain by the Combination Treatment of Trigger Point Blocks, Vitamin C and OH-B12

腹部肌筋膜痛引發的腹痛通常不易被診斷出來，而且需要和腹部內戚、腹部以外，或是其他原因所造成的腹痛鑑別診斷。在臨床上用來治療肌筋膜痛有許多的方法，通常需合併多種治療方式以達到疼痛的緩解及完全的恢復。我們報告一位72歲男性病患接受腹主動脈瘤切除手術後產生持續性腹痛，且無法以非類固醇抗發炎藥及病患自動式止痛的方式經靜脈給予嗎啡緩解疼痛。在排除其他原因後，我們診斷病人為左側腹直肌和雙側腹外斜肌肌筋膜炎。因維生素缺損也是肌鱗膜痛的誘發因素，在此病人中有許多維生素缺損的危險因子。於是我們給予病人營養治療及 引發點阻斷。營養治療以每日點滴注射維生素連續五天，第一天維生素。H-Bl2 5000mcg 和維生素C2500嗯，往後四天維生素C1500mg O 腹痛情形由刺痛變成鈍痛。治療前，我 們測血中維生素c 的濃度小於2.5µg／ml，維生素Bl2 ： 157 pg／ml。治療後，血中維生素C為7 .68 µ g／ml，維生素Bl2 ： 830 pg／ml。按著，我們在每個引發點上各注射0.5ml 1% lidocaine，次數為一個禮拜兩次。經上述治療後疼痛完全消失。病人出院後經6個月追蹤，沒有任何症狀再復發。

Myofascial pain syndrome in the abdominal musculature is often difficultly diagnosed and differentiated from the abdominal pain from the extra-abdominal source, abdominal viscera or other etiologies. We reported a 72-years-old patient after aneurysmectomy suffered from persistent abdominal pain, not relieved by nonsteroidal anti-inflammatory drugs (NASIDs) and IVPCA with morphine administration. Abdominal myofascial pain syndrome was diagnosed after ruling out other etiologies. Several predisposing factors of vitamin deficiency were found in this patient. A combination treatment of trigger point blocks and nutrition supplement was given. The initial dose was vitamin OH-B12 5000mcg and vitamin C 2500mg administrated as intravenous infusion. Sharp pain dramatically decreased to dull pain. Four maintenance doses with vitamin C 1500 mg per day were administrated. The blood ascorbic acid concentration was below 2.5 µ glml before intravenous administration, then increased to 7.68 µ glml. The initial blood vitamin B12 concentration was 157pg/ml then increased to 830 pg/ml. Numeric verbal pain score decreased from 7 to 4. Each of trigger points was injected with 0.5ml 1 % lidocaine twice in a week. Abdominal pain subsided completely after trigger point blocks. He was discharged and followed up for six months without symptoms and signs relapse.