神经阻滞对亚急性期带状疱疹神经痛的治疗作用

The effects of nerves block for subacute herpetic neuralgia

目的 观察神经阻滞在临床治疗亚急性期带状疱疹神经痛中的作用。方法 42例亚急性期带状疱疹神经痛的患者,随机分为药物治疗组（A组）和神经阻滞加药物治疗组（B组）。A组常规治疗用药：缓释曲马多50 mg,每12 h口服1次,甲钴胺0.5 mg,每8 h口服1次,腺苷钴胺1 mg,每24 h肌注1次。B组在A组的基础上应用神经阻滞治疗,根据皮肤疱疹和疼痛部位,确定其相应的支配神经给予药物阻滞;配方：2%利多卡因注射液5 ml＋腺苷钴胺1mg＋倍他米松注射液7 mg＋0.9%生理盐水至15 ml,每2周1次。采用视觉模拟疼痛评分（VAS）及匹兹堡睡眠质量指数（PSQI）评分对治疗前及治疗后1周、2周、4周及8周的疗效进行评价。结果 两组治疗后8周内VAS评分均较治疗前明显降低（P〈0.05）,但A组VAS评分下降缓慢,8周时才降至3分以下;而B组在治疗后第1周VAS评分即降至3分以下,且治疗后1～8周B组的VAS评分均明显低于A组（P〈0.05）。两组治疗后PSQI评分也均较治疗前明显降低（P〈0.05）,B组治疗后第1周PSQI评分就开始明显改善,与A组相比,差异有统计学意义P〈0.05）。结论 合用神经阻滞可以缩短带状疱疹神经痛和疼痛症状解除的时间,提高患者睡眠质量,有助于预防带状疱疹后遗神经痛。

Objective To evaluate the effectiveness of nerve block for subacute herpetic neuralgia.Methods Fourty-two patients with subacute herpetic neuralgia were randomly divided into two groups,control group A（n=22） and the observe group B（n=20）.In group A,patients were given controlled-release form of tramadol 50 mg,q12 h,po; mecobalamin capsules 0.5 mg,q8 h,po; cobamamide injection,q24 h,im.In group B,besides of the treatment of group A,selective nerves block was performed.The nerves were blocked according to the location of pain and herpes.The injections for nerves block was consisted of 5 ml 2% lidocaine,1 ml cobamamide,7 mg compound betmethasone and 0.9% saline,once a time for every 2 weeks,and 3 times in total.The effectiveness after 1,2,4,8 weeks using were evaluated with the Visual Analogue Scale（VAS）and Pittsburgh Sleep Quality Index（PSQI）.Results The VAS scores of the two groups decreased significantly than those before the treatment（P〈0.05）.But in group A,the VAS score dropped slowly,at 8 weeks after treatment,the VAS score became lower than 3.In group B,the VAS score dropped lower than 3 quickly during the first week after treatment.The VAS score in group B was significantly lower than that in group A during 1 to 8 weeks after treatment（P〈0.05）.The PSQI scores of the two groups decreased significantly than those before the treatment（P〈0.05）,and in group B,the PSQI score dropped quickly during the first week after treatment,and it showed significant difference when compared to that in group A.Conclusion Combination of nerves block with drugs can shorten the duration and extent of pain in patients with subacute herpetic neuralgia,and this treatment regimen can improve the quality of the patients＇ sleep.