连续硬膜外输注消炎镇痛液治疗不同病程带状疱疹后遗神经痛的疗效研究

Outcome study of continuous epidural block with analgesia for postherpetic neuralgia of different course

目的:比较连续硬膜外输注利多卡因和甲基强的松龙对不同病程带状疱疹后遗神经痛(PHN)患者的治疗效果。方法:胸腹部PHN患者70例,皮损位于T3-T11脊神经支配区。按照入院时疼痛持续的时间分为5组:Ⅰ组(n=13),疼痛持续1—2个月;Ⅱ组(n=15),疼痛持续2—3个月;Ⅲ组(n=16),疼痛持续3—6个月;Ⅳ组(n=12),疼痛持续6—12个月;Ⅴ组(n=14),疼痛持续12个月以上。所有患者在CT引导下置入硬膜外导管,采用硬膜外自控镇痛泵输注利多卡因和甲基强的松龙,连续输注18—20d,如果患者自控镇痛次数超过10次/d,则加用曲马多进行治疗。采用数字模拟评分法(NRS)评定疼痛强度。结果:硬膜外阻滞期间所有患者均达到满意镇痛,但Ⅲ组、Ⅳ组、Ⅴ组的镇痛泵使用数量和曲马多用量显著高于Ⅰ组、Ⅱ组;出院后7d,总有效率100%,组间无显著差异(P>0.05),但Ⅰ组和Ⅱ组的NRS评分明显低于Ⅴ组(P<0.05)。出院后3个月和6个月,Ⅰ组和Ⅱ组的有效率仍明显高于Ⅲ组、Ⅳ组和Ⅴ组(P<0.05);出院后3个月,Ⅲ组、Ⅳ组和Ⅴ组患者的NRS亦明显高于Ⅰ组和Ⅱ组(P<0.05)。出院后6个月,Ⅰ组患者的NRS明显低于其他4组(P<0.05);除Ⅰ组外,其余各组均有高于20%的患者治疗无效。患者的生存质量评分与疼痛程度密切相关(R2=0.945)。结论:连续硬膜外输注利多卡因和甲基强的松龙对病程<3个月的PHN患者的疗效优于病程≥3个月的患者。

Objective： To compare the efficacy of continuous epidural block with lidocaine and methylprednisolone in the patients of different course of postherpetic neuralgia（PHN）. Method： A total of 70 patients, diagnosed as PHN involved the dermatome of T3-Ⅲ spinal nerve, were recruited. Patients whose pain was persisted 1-2 months were allocated to group I （n=13）, 2--3 months to group Ⅱ （n=15）, 3-6 months to group Ⅲ （n=16）, 6--12 months to group IV （n=12）, and more than 12 months to group V （n=14）. All patients were given epidural catheter under the guidance of CT and infusion of lidocaine and methylprednisolone by a patient-controlled analgesia（PCA） pump for 18 to 20 consecutive days. If the patients pressed the pump to control their pain more than 10 times/d, tramadol was prescribed to relieve the pain. The number of PCA pump and doses of tramadol were calculated. Numeric rating scale（NRS） was used to evalu- ate pain intensity. Result： During the period of epidural blockage, all patients and group V needed more pump and tramadol than group pain alleviated, but patients in group m, group Ⅳ I and group 1I （P〈 0.05）. Seven d after treatment all patients got pain relief in different extent, total effective rate was 100%, there was no difference among 5 groups （P〉0.05）. Pain intensity NRS scores in group Ⅰ and group Ⅱ were lower than that in group V （P〈 0.05）. At 3months and 6months after treatment the effective rates in group I and group [I were higher than that in group Ⅲ, group Ⅳ, and group V （P〈0.05）. Pain NRS scores in group m, group IV, and group V were higher than group I and group Ⅱ （P 〈 0.05）. At the end of 6months after treatment NRS in group I was significantly lower than that in other 4 groups（P 〈 0.05） and 20% patients in the other 4 groups didn＇t get any effect after the treatment. The scores of quality of life in these patients had a close correlation with pain intensity （R^2=0.945）. Conclusion： Continuous epidural infusion of lidocaine and methylprednisolone had better efficiency in patients with PHN less than 3 months.