超声引导下竖脊肌平面阻滞联合普瑞巴林对带状疱疹后神经痛的疗效分析

Ultrasound-guided erector spinae plane block combined with pregabalin for post-herpetic neuralgia

目的分析超声引导下竖脊肌平面阻滞联合普瑞巴林对老年胸背部带状疱疹后神经痛(PHN)的临床疗效。方法选择蚌埠医学院第一附属医院疼痛科2018年1月至2019年1月胸背部带状疱疹后神经痛患者60例,按照随机数字表法分为两组(n=30):对照组(C组)和超声引导下竖脊肌平面阻滞组(ESPB组)。C组采用口服普瑞巴林进行治疗;ESPB组采用超声引导下竖脊肌平面阻滞联合口服普瑞巴林治疗。观察记录两组患者治疗前及治疗后1、2、3、4、6、8周的数字评定量表(NRS)评分、睡眠质量评分(QS)、普瑞巴林总用量以及治疗期间发生的相关不良反应情况。结果ESPB组患者治疗后4周的NRS评分、QS评分分别为2.00(2.00~3.00)、1.00(1.00~2.00)分,显著低于C组的3.00(3.00~4.00)、2.00(2.00~3.00)分,差异均有统计学意义(Z=-2.318、-2.533,均P<0.05)。ESBP组患者治疗4周普瑞巴林的用量为1.73(1.65~1.99)g,少于C组的7.28(7.28~7.28)g,差异有统计学意义(Z=-4.808,P<0.05)。ESPB组患者随访的第8周NRS评分、QS评分分别为2.50(2.00~4.00)、1.00(0.00~2.00)分,显著低于C组的4.00(3.00~4.00)、1.00(1.00~2.00)分,差异均有统计学意义(Z=-2.426、-2.691,均P<0.05)。ESPB组治疗的显著有效率为70.0%,明显优于C组的36.7%,差异有统计学意义(χ^2=6.694,P<0.05)。两组患者不良反应均较轻。结论超声引导下竖脊肌平面阻滞可以有效缓解老年胸背部PHN患者的疼痛,明显减少口服药物的用量,改善患者睡眠质量,且安全性较高。

Objective To analyze the clinical effect of ultrasound-guided erector spinae block combined with pregabalin on post-herpetic neuralgia (PHN) in the elderly. Methods Sixty patients with post-herpetic neuralgia from January 2018 to January 2019 in the Department of Pain, First Affiliated Hospital of Bengbu Medical College were selected. The patients were divided into two groups according to the random number table (n=30): group C and ultrasound-guided erector spinae block (ESPB) group. Group C was treated with the oral drug pregabalin. ESPB group was treated with ultrasound-guided erector spinae block combined with oral drug pregabalin. The digital rating scale (NRS) score, sleep quality score (QS), total pregabalin dosage, and correlation during treatment were recorded before and after treatment at 1, 2, 3, 4, 6, and 8 weeks after treatment. Results Four weeks after treatment, the scores of NRS and QS in ESPB group were 2.00(2.00-3.00) and 1.00(1.00-2.00) respectively, which were significantly lower than those in group C 3.00(3.00-4.00) and 2.00(2.00-3.00). The differences were statistically significant (Z=-2.318,-2.533, all P<0.05). The dosage of pregabalin in ESBP group was 1.73(1.65-1.99)g, less than that in group C 7.28(7.28-7.28)g, and the difference was statistically significant (Z=-4.916, P<0.05). The NRS score and QS score of ESPB group at the 8th week of follow-up were 2.50(2.00-4.00) and 1.00(0.00-2.00), respectively, which were significantly lower than those of group C 4.00(3.00-4.00) and 1.00(1.00-2.00). The difference was statistically significant (Z=-2.426,-2.691, all P<0.05). The significant effective rate of ESPB group was 70.0%, which was significantly better than that of group C (36.7%). The difference was statistically significant (χ^2=6.694, P<0.05). Adverse reactions were mild in both groups. Conclusion Ultrasound-guided erector spinae block can effectively alleviate the pain of elderly patients with PHN in the chest, significantly reduce the dosage of oral drugs, improve the sleep quality of patients, and have higher safety.