三年及以上病程带状疱疹后神经痛50例临床分析

Treatment for patient with chronic postherpetic neuralgia

回顾性分析2012-2017年山西省人民医院疼痛科诊治的50例病程≥3年的带状疱疹后神经痛患者的临床资料。根据疱疹不同部位行相应的责任神经阻滞及皮损区皮下注射,观察疼痛数字分级量表(NRS)和生命质量评分。药物为利多卡因≤300mg、地塞米松磷酸钠注射液2mg、维生素B12 0.5mg,利多卡因浓度:椎旁阻滞0.3%,神经丛和周围神经1.0%,皮下注射0.3%。神经阻滞时针尖顶住骨性标志再下滑,避免盲目穿刺;注药前要回吸;进针缓慢,避免神经损伤。治疗前、治疗结束及随访1、3、6个月间NRS评分差异有统计学意义(F=279.6,P<0.01)。与治疗前相比,治疗结束时和随访1、3及6个月时,患者的NRS评分下降、生命质量的升高差异有统计学意义(均P<0.01)。其中治愈16例,有效22例,微效11例,无效1例,治疗效果与皮肤有否瘢痕、是否伴随异常性疼痛有关。

Fifty postherpetic neuralgia (PHN)patients with a course ≥3years and the Pain Numeric Rating scale (NRS)≥5were included in the analysis.All patients were treated with nerve block and subcutaneous injection in the affected area.The paravertebral nerve blocks were performed by injecting 5ml lidocaine in the concentrations of 0.3%;the concentration of lidocaine for branch blockage and peripheral nerves was 1.0%,and that for subcutaneous injection was 0.3%,respectively;2mg dexamethasone and 0.5 mg vitamin B12were added in the injections.The NRS scores and quality of life scores were documented before and after the treatment.The NRS score was significantly decreased at different time points of treatment (F=279.6,P<0.01).At the end of the treatment and at 1month,3months,6months of follow-up,the scores were significantly lower than those before the treatment.All patients showed enormous improvement in the quality of life at 1,3and 6months after treatment.The pain relief was "excellent"or "good"in 38 cases.The efficacy of treatment is associated with skin scar and allodynia.The study indicates that nerve block and subcutaneous injection has a satisfactory efficacy in treatment of chronic postherpetic neuralgia.