连续外周神经阻滞治疗带状疱疹后神经痛的临床研究

Clinical research of continuous peripheral nerve block on patients with postherpetic neuralgia

目的评价连续外周神经阻滞治疗带状疱疹后神经痛的效果。方法选取符合带状疱疹后神经痛诊断标准的患者60例,采用连续外周神经阻滞治疗,观察治疗前及治疗后1周、4周、24周、48周的疼痛程度及日常生活质量,并观察不良反应。采用视觉模拟评分法(VAS)进行疼痛评分,按照中国SF-36量表对生活质量进行评分。结果 60例患者治疗后1周总有效率为83.3%(50/60),治疗后48周总有效率达到93.3%(56/60),近期和远期疗效比较差异有统计学意义(P<0.01)。治疗后第1周末、第4周末、第24周末、第48周末,VAS分值分别为(3.49±1.91)、(2.86±1.68)、(2.35±1.64)、(2.18±1.55)分,较治疗前的(8.61±0.73)分显著下降(t=19.34,P<0.01),且治疗后第48周末VAS分值与治疗第1周末比较明显降低(t=4.11,P<0.01);生活质量评分分别为(62.98±15.18)、(72.86±15.68)、(78.35±13.54)、(80.40±12.67)分,较治疗前的(36.78±10.70)分明显提高(t=10.92,P<0.01),且治疗后第48周末生活质量评分与治疗后第1周末比较,差异亦有统计学意义(t=6.82,P<0.01)。治疗期间无明显不良反应,无效者均为颜面部侵犯三叉神经患者。结论连续外周神经阻滞治疗带状疱疹后神经痛疗效确切,安全可靠,无明显不良反应,值得临床推广。

Objective To evaluate the effects of continuous peripheral nerve block on patients with postherpetic neuralgia. Methods 60 patients who met the diagnostic criteria for postherpetic neuralgia were selected, they received the treatment of continuous peripheral nerve block, the efficacy was assessed by visual analogue scale（VAS） and life quality, the adverse reactions were observed after treatment. The scores of life quality and VAS scales were evaluated before and decreased at 1,4,24,48 weeks after the treatment. Results Total effective rate for 1 week after treatment in 60 cases was 83.3% ,total effective rate reached 93.3% for 48 weeks after treatment,the short-term and long-term effects of a statistically significant difference （ P 〈 0. O1 ）. After treatment lth, 4th, 24th,48th weekend, VAS score were （ 3.49 ± 1.91 ）, （ 2.86± 1. 68 ）, （2.35 ± 1.64）, （2.18 ± 1.55 ） respectively, compared with before treatment （ 8.61 ± 0.73 ） scores de- creased significantly（ t = 19.34 ,P 〈 0.01 ） , there was significantly reduced VAS scores at 48th week after treatment than that at lth week after treatment（t =4.11 ,P 〈0.01 ） ;quality of life scores were （62.98 ± 15.18）, （72.86 ± 15.68）, （ 13.54 ± 78.35 ）, （ 80.40 ± 12.67 ） respectively, compared with before treatment （36.78 ± 10.70） scores increased significantly（ t = 10.92 ,P 〈 0.01 ）, and the quality of life at 48th week after treatment had significant differences compared with the 1 th week ＇after treatment （ t = 6.82, P 〈 0.01 ）. No significant adverse reactions occurred during treatment, void of all facial abuse in patients with trigeminal neuralgia. Conclusion The continuous peripheral nerve block was a safe and effective method for the patients with postherpetic neuralgia, with no obvious adverse effects and was worthy of promotion.