带状疱疹相关性疼痛三期疗效评价及心理干预

The therapeutic evaluation and psychological intervention of pain associated with herpes zoster in the three phases

目的探讨带状疱疹相关性疼痛(ZAP)三期治疗效果,为临床上综合治疗和心理干预提供理论依据。方法选择2013年1月-2014年1月在新疆医科大学第一附属医院疼痛科住院的52例ZAP患者,进行综合治疗(神经阻滞治疗+抗病毒+止痛药物+营养神经药物+抗惊厥药物+物理疗法(偏振光)+心理干预治疗(认知-行为疗法和心理支持),采用视觉模拟(VAS)评分法和抑郁自评量表(SDS)评估治疗前后三期(急性期、亚急性期、PHN期)的疼痛程度及抑郁程度。结果 ZAP患者治疗后急性期、亚急性期、PHN期疼痛程度(VAS)评分明显低于治疗前,差异有统计学意义(P<0.01);急性期、亚急性期总有效率(100.0%)与PHN期(81.0%)比较差异有统计学意义(P<0.05);治疗后三期抑郁自评量表(SDS)评分低于治疗前,差异有统计学意义(P<0.05)。结论综合治疗+心理干预治疗对ZAP患者三期疼痛控制疗效显著,抑郁程度明显减轻,急性期、亚急性期疗效显著,联合运用治疗方法,值得在临床上推广使用,并可将心理干预方法贯穿于ZAP三期治疗的每一个环节中,尤其PHN期需强化。

Objective To investigate the therapeutic effect of the three phases of herpes zoster-associated pain（ZAP）,and to provide the theoretical basis for the comprehensive treatment and psychological intervention.Methods 52 patients with ZAP who were hospitalized in the First Affiliated Hospital of Xinjiang Medical University from January 2013 to January 2014,were treated comprehensively（combined with nerve blocking treatment,antiviral therapy,analgesics,nerve nutrition drugs,anticonvulsant,physical therapy（polarized light）and psychological intervention（cognitive-behavioral therapy and psychological support）and evaluate pain degree and depression degree before and after treatment in the three phases（acute,sub-acute and PHN phase）by visual analogue scale（VAS）and self-rating depression scale（SDS）.Results The VAS score of ZAP patients in acute,sub-acute,and PHN phase were significantly lower than those before treatment（P 〈0.01）;the differences of total effective rate between the acute,sub-acute and PHN phase were statistical significant（acute/sub-acute：PHN=100%：81.0%,P 〈0.05）;the SDS score after treatment in the three phases were lower than before,which difference was significant（P 〈0.05）.Conclusion The therapeutic effect with comprehensive treatment and psychological intervention treatment for ZAP patients with three pain control are profound,and the reduction of the degree of depression is significant,so it is worth popularizing the combination treatment method in clinical and psychological intervention could be running through every phase of ZAP treatment,especially being strengthened in PHN phase.