高能量激光辅助治疗带状疱疹性神经痛的临床研究

The clinical study of the auxiliary value of high intensity laser therapy in the treatment of herpetic neuralgia

目的:观察高能量激光辅助治疗急性期胸段带状疱疹疼痛的疗效、皮损愈合情况以及带状疱疹后神经痛(postherpetic neuralgia,PHN)的发生率。方法:选取2017年2月至2018年5月于我科住院治疗的86例老年胸段带状疱疹急性期病人,随机分为S组(标准组)和L组(激光组),每组43例。两组均行抗病毒、口服镇痛药物及超声引导下胸椎旁神经阻滞治疗,L组在此基础上每日行皮损部位高能量激光照射,S组接受假激光照射,连续治疗1周。记录两组病人治疗前和治疗后1周、1月、2月、3月和6月时视觉模拟评分法(visual analog scale,VAS)评分、睡眠状况自评量表(self-rating scale of sleep,SRSS)评分和皮损持续时间以及治疗后镇痛药物使用率;同时记录两组治疗期间平均每日盐酸曲马多使用量、补救药物使用例数以及不良反应发生情况,并随访观察疱疹皮损愈合后1月时PHN的发生率。结果:与治疗前比较,两组病人治疗后1周、1月、2月、3月和6月时VAS和SRSS评分均有明显改善(P<0.05);与S组比较,L组治疗后1周、1月和2月VAS评分以及治疗后1周、1月、2月和3月SRSS评分均显著降低(P<0.05)。L组疱疹皮损持续时间较S组显著缩短(P<0.05);L组治疗期间平均每日盐酸曲马多使用量显著低于S组(P<0.05);L组病人治疗后1月、2月和3月时镇痛药物使用率均较S组显著降低(P<0.05)。同时,L组病人治疗期间补救药物使用率、总不良反应发生率和PHN发生率均显著低于S组(P<0.05)。结论:急性胸段带状疱疹病人早期行皮损部位高能量激光治疗,可以加快皮损愈合、更有效地缓解疼痛、减少镇痛药物使用,同时可以降低PHN发生率。

Objective:To evaluate the efficacy of high intensity laser therapy(HILT)in acute thoracic herpes zoster pain,eruptive duration,and the incidence of postherpetic neuralgia(PHN).Methods:Eighty-six patients over 60 years of age with acute thoracic herpetic eruption were randomly assigned to the standard group(group S,n=43)and the laser group(group L,n=43).Both groups were treated with conventional drug treatment including antiviral drugs and analgesics and received ultrasound-guided thoracic paravertebral nerve block(USG-TPVB);and on this basis,the L group received daily high intensity laser therapy on the skin lesions,and the S group received sham laser therapy for 1 week.The curative effect was evaluated at 1 w,1 m,2 m,3 m and 6 m after the end of the treatments by visual analogue scale(VAS),self-rating scale of sleep(SRSS),and the proportion of patients consuming analgesics,healing time of the skin lesions,and usage rate of analgesics after treatment.The daily consumption of tramadol hydrochloride,the use of rescue analgesia(oxycodone),adverse reactions during the treatments,and the incidence of PHN at 1 m after the healing of herpetic skin lesions were also recorded.Results:VAS and SRSS in both groups decreased significantly at different time points after treatments compared with basal(P<0.05).Group L showed significantly lower VAS at 1 w,1 m,2 m and significantly lower SRSS at 1 w,1 m,2 m,and 3 m after the treatments compared to group S(P<0.05).Group L also showed lower proportion of patients consuming analgesics at 1 m,2 m,and 3 m after the treatments(P<0.05).Significantly shorter herpetic eruption was noticed in group L compared to group S(P<0.05).The daily consumption of tramadol hydrochloride and the use of rescue analgesia during hospitalization in group L were also significantly lower than that in group S(P<0.05).A significantly lower incidence of PHN and total adverse reactions was noted in group L(P<0.05).Conclusion:High intensity laser therapy is an effective adjunct in alleviating acute thoracic HZ pain,and it can shorten the duration of herpetic eruption and decrease the incidence of PHN.