连续腰大肌肌间沟阻滞治疗下肢带状疱疹后遗神经痛的临床观察

The effects of continuous nerve block in the psoas major space for the treatment of lumbocrural postherpetic neuralgia

目的探讨应用连续腰大肌肌间沟阻滞法治疗下肢带状疱疹后遗神经痛(PHN)的可行性及疗效观察。方法选择26例下肢PHN患者随机分为2组,观察组(A组,16例)采用0.4%～0.8%利多卡因4ml/h连续腰丛神经阻滞治疗4周,对照组(B组,10例)口服曲马多缓释片100mg,3次/d,4周后停止服药。记录治疗前(T0)、治疗后15d(T1)、30d(T2)、90d(T3)和180d(T4)的疼痛视觉模拟(VAS)评分,评价疗效及记录并发症。结果A组VAS评分在T1～T4较T0明显降低(P<0.01),T2～T4较T1增加(P<0.01),T3与T4之间差异无统计学意义(P>0.05)。B组T1较T0明显减轻(P<0.05)。T2、T3、T4时2组间VAS评分,B组均较A组高(P<0.01);A组T1优良率达100%,T2、T3、T4优良率均为75.0%,有效率均为87.5%,均高于B组同期百分比。结论连续腰大肌肌间沟阻滞治疗下肢PHN效果可靠,复发率低,简单易行,安全有效。

Objective To investigate the feasibility and effects of continuous nerve block in the psoas major space for the treatment of lumbocrural postherpetic neuralgia（PHN） .Methods Consecutive 26 cases with lumbocrural PHN were divided into 2 groups. The observation group（group A, n = 16） were underwent continuously lumbar plexus block, and the epidural catheters were placed percutaneously into the psoas major space through epidural puncture needles,0.4% -0.8% lidocaine was given at 4 ml/h for 4 weeks.While, the control group（group B, n = 10） were given tramadol sustained release tablets 100 mg,three times per day for 4 weeks.The pain VAS scores and therapeutic effect were recorded before the treatments（ T0 ）, and 15 d（ T1 ）,30 d（ T2 ）,90 d（T3 ） and 180 d（T4 ） after treatment, and the complications were observed. Results The pain VAS of group A at T1 - T4 achieved obviously relief（ P 〈 0.01）, and T2 - T4 were increased than T1 （ P 〈 0.01）,no statistical difference between T3 and T4（ P 〉 0.05）.In group B, the pain VAS in T1 was lower than T0, while it was higher than that of group A at T2 - T4 （ P 〈 0.01 ）. The effective rate were 100% in group A at T1, and 75.0% at T2 ,T3 ,T4 .All effective rate was higher in group A than group B at the corresponding lime period. Couclusion It suggested that continuous nerve block in the psoas major space for the treatment of lumbocrural PHN was one of feasible, simply, safety and effective approach.