高压氧治疗带状疱疹后遗神经痛的临床疗效观察

Clinical research on the effect of hyperbaric oxygen for postherpetic neuralgia

目的:观察高压氧(hyperbaric oxygen,HBO)治疗带状疱疹后遗神经痛(postherpetic neuralgia,PHN)患者的临床疗效。方法:60例PHN患者按照随机数字法分为对照组和治疗组,每组30例。两组均以卡马西平(CBZ)为单一治疗药物。治疗组给予HBO治疗;对照组在模拟HBO舱环境中,戴面罩吸空气,疗程为10d。治疗期间患者维持原有药物方案。治疗后根据视觉模拟评分(VAS)变化调整CBZ剂量,并进行6个月随访疼痛评估,对患者CBZ剂量、VAS和患者对治疗总体感觉(patients'global impression of change,PGIC)进行测评。结果:对照组1例患者未完成治疗,在随访1、3、6个月又各脱落1例患者,共26例患者完成研究;治疗组在随访的1、3、6月各脱落1例患者,共27例患者完成研究。治疗后,VAS前-后减少≥2的治疗组患者为22(30)例,对照组为13(29)例,两组具有显著性差异(P=0.026);PGIC中明显好转或轻度好转的治疗组患者占66.67%(20/30),高于对照组37.93%(11/29)(P=0.019)。随访第1、2个月,治疗组患者CBZ量为(227.59±122.17)mg/d和(231.03±113.71)mg/d,对照组为(310.71±152.36)mg/d和(296.43±126.15)mg/d,两组比较具有显著性差异;尤其在第1个月随访时,治疗组CBZ用量减少百分比多于对照组(P=0.012)。随访第6月末,VAS前-后减少≥2的治疗组患者为17(27)例,多于对照组9(26)例,两组比较差异有显著性意义(P=0.039);患者对治疗的总体感觉中明显好转或轻度好转的治疗组患者占62.96%(17/27),高于对照组38.46%(10/26),两组具有显著性差异(P=0.037)。结论:HBO治疗能减少PHN患者CBZ药物剂量,改善患者生存质量。

Objective：To observe the clinical efficacy of hyperbaric oxygen （HBO） in treatment of postherpetic neuralgia （PHN）. Method：Sixty patients with PHN were divided into control group and treatment group with 30 cases each by table of random digit. Besides carbamazepine（CBZ）, the patients in treatment group were assigned to receive HBO therapy for 10 days, while imitation environment chamber therapy as control. The change of CBZ dos- age was according to the scores of visual analogue scale（VAS） till the end of treatment. Efficacy was evaluat- ed at the end point of treatment and at the lst,3rd and 6th months after treatment, by CBZ dosage, VAS and patients＇ global impression of change （PGIC）. Result： Fifty three patients completed the study, 26 in control group and 27 in treatment group. At the end point of treatment, in 22（30） patients of treatment group VAS score decreased more than 2 and in 13（29） pa- tients of control group, with significant statistical difference between the two groups （P=0.026）; 20/30 （66.67%） patients of treatment zrouo and 11/29 （37.93%） tatients of control froun rated mild ira_proved on the patient＇s global impression of change（PGIC） （P=0.019）. In 1 and 2 month follow up time point, the CBZ dosages in treatment group were （227.59±122.17） mg/d and （231.03±113.71） mg/d; while in control group, the CBZ dosages were （310.71±152.36） mg/d and （296.43±126.15） mg/d respectively, there was signifi- cant statistical difference between the two groups. Particularly, in the Ist month follow-up phase, the percent- age of mean decreased CBZ dose of patients in treatment group was more than which in control group, there was significant difference. At the 6th month, the VAS score decreased more than 2 was 17（27） in treatment group, and 9（26） in control （P=0.039）; 17/27（62.96%） in treatment group rated themselves much or mild im- proved on the PGIC, more than that in control group （P=0.037）. Conclusion： HBO therapy could improve the quality of life of PHN patients, and suggested that HBO was a potential effective therapy for patients with neuropathic pain.