利多卡因乳膏介导体外冲击波治疗带状疱疹后神经痛的可行性及有效性

Feasibility and efficacy of lidocaine cream-mediated extracorporeal shock wave therapy for postherpetic neuralgia

目的综合评价利多卡因乳膏作为发散式体外冲击波介质治疗带状疱疹后神经痛的临床可行性及有效性。方法选择非头面部带状疱疹后神经痛患者90例,随机分为试验组和对照组,每组45例。试验组为利多卡因乳膏介导组,对照组为超声耦合剂介导组。治疗期间所有患者给予药物、发散式体外冲击波治疗、背根神经节射频调节术和神经阻滞术。此外,试验组采用利多卡因乳膏为发散式体外冲击波治疗的介质;对照组采用超声耦合剂为发散式体外冲击波治疗的介质。采用视觉模拟评分、触诱发痛治疗有效率和汉密尔顿抑郁量表,比较两组治疗前,治疗结束后即刻、2周、4周、8周和12周疼痛程度、触诱发痛情况和情绪情况;比较两组试验期间阿片类药物和普瑞巴林用量,并记录患者不良反应。结果疼痛程度评分比较:在治疗后即刻和2周时,试验组视觉模拟评分(VAS)分别为1.96±0.77和2.25±0.89;对照组VAS分别为2.97±0.79和3.40±0.81。与对照组比较,试验组VAS较低(P<0.05)。在治疗后4周、8周、12周时,试验组VAS分别为8.04±2.90、2.82±0.65和2.64±0.91;对照组VAS分别为2.87±0.61、3.07±0.72和2.98±0.72。两组VAS比较差异无统计学意义。阿片类药物和普瑞巴林用量比较:与对照组相比,试验组羟考酮和普瑞巴林用量较少。两组均未发现发散式体外冲击波治疗相关并发症。结论利多卡因乳膏作为发散式体外冲击波的介质,在治疗带状疱疹后神经痛时,可以降低疼痛程度,提高触诱发痛缓解率,减少普瑞巴林和阿片类药物用量,是一种安全、有效的治疗方式。

Objective To evaluate the clinical feasibility and efficacy of lidocaine cream being used as a divergent extracorporeal shock wave therapy(ESWT)for postherpetic neuralgia.Methods Ninety patients with non-head and face postherpetic neuralgia were randomly divided into two groups using the block randomization method.The treatment group(n=45)received lidocaine cream-mediated ESWT while the control group(n=45)was treated with ultrasonic couplant-mediated ESWT.Both groups received medication,ESWT,pulsed radiofrequency and nerve block.The Visual Analogue Scale(VAS),hyperalgesia,Hamilton Depression Scale(HAMD),doses of opioids and pregabalin and adverse reactions were observed in both groups for 12 weeks.Results Pain score comparison:Immediately after treatment and 2 weeks after treatment,the Visual Analogue Scale(VAS)of the treatment group was 1.96±0.77 and 2.25±0.89 respectively,compared with 2.97±0.79 and 3.40±0.81 in the control group.The doses of oxycodone and pregabalin were lower in the treatment group than in the control group.There were no complications related to ESWT in either group.Conclusions Our data suggests that lidocaine cream-mediated ESWT is effective and safe for PHN patients,which can be used as a supplementary treatment of PHN in grassroots hospitals.