连续硬膜外腔阻滞对带状疱疹后遗神经痛的疗效观察

Epidural block in the treatment of postherpetic neuralgia

目的比较两种治疗方法对带状疱疹后遗神经痛的治疗效果。方法选择带状疱疹后遗神经痛的患者64例,随机分两组,神经阻滞治疗组(A组,n=32)与连续硬膜外腔阻滞治疗组(B组,n=32),连续治疗3-4周。使用药物:B组0.4%-0.8%的盐酸利多卡因+地塞米松2mg+0.9%生理盐水共250ml,流速为5ml/h。A组0.4%-0.8%的盐酸利多卡因+地塞米松2mg+0.9%生理盐水共20ml,1次/3d,连续治疗3-4周。采用视觉模拟评分法(VAS法),分别测评治疗前、硬膜外镇痛、神经外镇痛、神经阻滞结束后及治疗结束后6个月的VAS评分、伴随症状的改善情况以及并发症,从而评估两种方法的疗效和安全性。结果治疗结束时及治疗后6个月时,两组VAS评分均较术前显著降低(P<0.05);两组间VAS评分比较,治疗结束时及治疗后6个月时B组较A组显著降低(P<0.05)。结论神经阻滞、连续硬膜外阻滞对带状疱疹后遗神经痛有明显缓解作用,连续硬膜外阻滞对带状疱疹后遗神经痛的治疗效果更佳。

Objective To compare the therapeutic effects of nerve block and continuously injected into epidural space in the treatment of postherpetic neuralgia.Methods 64 patients （31 males and 33 females） with postherpetic neuralgia were randomly dived into intermittent nerve block group （32 cases） and continous epidural space group（32cases）.Mixed liquor of 0.4%-0.8% lidocaine hydrochloride,dexmethasone 2mg and 0.9% NS （total volume 250 ml） had been infusioned continuously into epidural space at the rate of 5ml/h for continuous 3-4 weeks in epidural space group,and mixed liquor of 0.4%-0.8% lidocaine hydrochloride,dexamethasone 2mg and 0.9% NS （total volume 20ml） had been used once in four days for continuous 3-4 weeks in nerve block group.VAS evaluation,patients subjective evaluation were taken and side effects were observed before and after therapy,and six months after therapy.Results Compared with pretreatment,the value of VAS decreased significantly when leaving hospital and six months after therapy in each group （P0.01）;compared with nerve block group,the value of VAS decreased significantly when the patients left hospital and six months after therapy in epidural space group （P0.05）.Conclusion Epidural block in a row has a significant pain relief effect on postherpetic neuralgia.