口服加巴喷丁联合硬膜外药物注射治疗带状疱疹后神经痛的临床效果分析

Clinical Effects of Gabapentin Combined with Epidural Block in Treatment of Post-Herpetic Neuralgia

目的对比分析口服加巴喷丁联合硬膜外药物注射及单纯口服加巴喷丁对带状疱疹后神经痛的治疗效果。方法选择带状疱疹后神经痛患者74例,随机分为A、B两组,A组患者口服加巴喷丁胶囊联合硬膜外药物注射;B组患者仅口服加巴喷丁胶囊。分别于治疗前和治疗后7、15、30 d时对A组和B组的患者采用视觉模拟(VAS)评分及威斯康星简要疼痛目录评分进行评价,并观察两种治疗方法的并发症和药物的不良反应,以及需要增加镇痛措施的情况。结果治疗后两组患者7、15、30 d VAS评分及威斯康星简要疼痛目录评分比较,差异均有统计学意义(P<0.05),且组内不同时间点评分比较差异有统计学意义(P<0.05)。A组有1例穿刺部位疼痛较重,经局部注射治疗后缓解;发生头晕3例、嗜睡3例、恶心4例及口干2例。B组发生头晕8例、嗜睡5例、恶心5例及口干3例。A组有8例患者因效果欠佳,临时口服曲马朵缓解疼痛,共口服34次,总剂量2 750 mg。B组有14例患者加用曲马朵,共口服69次,总剂量5 650 mg。结论两种治疗方法对带状疱疹后神经痛均有一定的效果,口服加巴喷丁联合硬膜外药物注射治疗效果更佳,能迅速减轻早期带状疱疹后神经痛。

Objective To explore the curative effects of gabapentin,with or without epidural block,in the treatment of post-herpetic neuralgia and to evaluate the clinical outcomes.Methods A total of 74 patients with post-herpetic neuralgia were divided randomly into two groups：group A and group B.Patients were treated with gabapentin with（group A） or without epidural block（group B）.Verbal analogue scale（VAS） and Wisconsin brief pain inventory were used for the evaluation of pain before treatment and on the 7th,15th,and 30th day of treatment,with the complications,adverse effects and additional pain-relieving measures necessary recorded.Results Comparison of VAS scores and Wisconsin brief pain inventory scores at the 7th,15th,and 30th day of treatment between the two groups all showed significant differences（P0.05）;and these two scores were significantly different among different time points within each group（P0.05）.One case from group A suffered severe pain in the puncture site,which was relieved after local injection.Three cases of dizziness,3 cases of somnolence,4 cases of nausea,and 2 cases of thirsty were recorded in group A.Eight cases of dizziness,5 cases of somnolence,5 cases of nausea,and 3 cases of thirsty were recorded in group B.Eight patients in group A took Tramadol orally for lack of efficacy（34 times in total;total dose,2 750 mg）.Fourteen patients in group B took Tramadol orally for lack of efficacy（69 times in total;total dose,5 650 mg）.Conclusion Both therapies have positive effects in the treatment of post-herpetic neuralgia,while gabapentin with combined epidural block is significantly more effective,especially in the early phase of post-herpetic neuralgia.