交感神经阻滞治疗带状疱疹后遗痛

Treatment of postherpetic neuralgia by sympathetic nerve block

目的观察交感神经阻滞治疗带状疱疹后遗痛(PHN)的临床疗效。方法将55例PHN患者分入药物治疗组(26例)和交感神经阻滞组(29例)。药物治疗组口服加巴喷丁、曲马多、维生素B12和维生素C治疗。交感神经阻滞组在药物治疗的基础上,在与病变区域相对应的神经支配节段于C型臂X线透视机引导下行交感神经阻滞治疗。分别于治疗前、治疗后1周、治疗结束时和治疗后3个月采用疼痛视觉模拟评分(VAS评分)评估疼痛程度。记录治疗后3个月患者病变部位的麻木、痛觉过敏和超敏、睡眠障碍、焦虑等症状的改善情况。结果两组治疗后1周、治疗结束时、治疗后3个月的疼痛VAS评分均较同组治疗前显著降低(P值均<0.01)。交感神经阻滞组治疗结束时、治疗后3个月的疼痛VAS评分均显著低于药物治疗组同时间点(P值均<0.01)。两组患者的麻木、痛觉过敏和超敏、睡眠障碍、焦虑等症状均较治疗前改善,交感神经阻滞组的总有效率为96.6%(28/29),显著高于药物治疗组的84.6%(22/26,P<0.05)。结论药物治疗结合交感神经阻滞对PHN及其他临床症状的改善作用明显优于单纯药物治疗,且安全有效。

Objective To explore the clinical outcome of sympathetic nerve block in the treatment of postherpetic neuralgia （PHN）. Methods Patients with PHN were randomly divided into group A （n = 26） and group B （n=29）. The patients in group A took orally gabapentin, tramadol, vitamin Blz and vitamin C. The patients in group B received sympathetic nerve block under the guidance of X ray and medicine treatment. Visual analogue scale （VAS） scores were recorded before treatment, at the end of treatment and one week and three months after treatment. The symptoms such as numbness, hyperalgesia, allodynia, sleep dysfunction and anxiety were also evaluated three months after treatment. Results VAS scores were significantly decreased at the end of treatment, one week and 3 months after treatment as compared with those before treatment in both groups （all P〈 0.01）. VAS scores in group B were significantly lower than those in group A at the end of treatment and three months after treatment （both P〈0. 01 ）. The symptoms including numbness, hyperalgesia, allodynia, sleep dysfunction and anxiety were significantly improved after treatment in both groups. Total effective rate in group B （96.6%, 28/29） was significantly higher than that in group A （84.6%, 22/26, P〈0.05）. Conclusion Sympathetic nerve block combined with medicine treatment is more beneficial and safe in relieving postherpetic neuralgia and related symptoms.