硬膜外阻滞联合药物治疗带状疱疹后神经痛的临床研究

Drugs with epidural block on treatment for post-herpetic neuralgia

目的:比较口服加巴喷丁和氨酚羟考酮联合硬膜外阻滞及口服加巴喷丁和氨酚羟考酮两种方法对带状疱疹后神经痛(PHN)治疗效果,并评估其临床应用价值。方法:选择符合标准的PHN患者96例,随机分为A、B两组,A组患者硬膜外阻滞联合口服加巴喷丁和氨酚羟考酮。B组患者口服加巴喷丁+氨酚羟考酮。分别于治疗前和治疗后1、3、7、15、30d,共6次,对A组和B组的患者采用视觉模拟评分(VAS)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,以及需要执行补救措施的病例数。结果:两组治疗后1、3、7、15、30dVAS评分及威斯康星简要疼痛目录评分,组间对照有显著性差异(P<0.05),且前后评分随着治疗时间而递减,组内不同时间点比较有显著性差异(P<0.05),A组患者除1例患者导管脱出外未出现明显的不良反应,而B组药物的副作用与A组相比,不良反应种类多且明显。结论:两种治疗方法对PHN均有一定的效果,但硬膜外阻滞联合加巴喷丁及氨酚羟考酮治疗效果更佳,尤其是早期使用,能迅速减轻疼痛。

Objective： To compare the effect of gabapentin combined with oxycodone and acetamin with or without epidural block on treatment of post-herpetic neuralgia（PHN）, and evaluate the clinical outcomes. Method：A total of 96 patients with PHN were divided randomly into two groups： group A and group B. Patients ere treated with gabapentin combined oxycodone and acetamin with （group A） and without epidural block （group B）. Visual analogue scale（VAS） and Wisconsin brief pain inventory were used for the evaluation. Complications and adverse effects of the two treatments were also observed. Result：After therapies for one month, there were significant difference in VAS and Wisconsin brief pain invento- ry in the two groups （P〈0.05）. And the scores decreased significantly with prolonging of treatment time（P〈0.05）. There was no obvious complication in both two groups; however, more adverse effects were observed in group B. Conclusion： Both of these therapies have positive effects on PHN treatment, but gabapentin combined, oxycodone and acetamin with epidural block is significantly more effective, especially in the early phase of PHN. Author＇s address Department of Pain Management,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,HuBei Province,430022