神经妥乐平椎旁阻滞和静脉给药治疗带状疱疹后神经痛的疗效比较

Comparison of therapeutic effects of neurotropin using paravertebral blockade and intravenous administration in post herpetic neuralgia

目的比较牛痘疫苗接种家兔炎症皮肤提取物神经妥乐平（NTP）椎旁阻滞和静脉给药治疗带状疱疹后神经痛的疗效。方法选择2015年1月至2016年4月我院疼痛科诊治的胸背部顽固性带状疱疹后神经痛患者80例,男42例,女38例,年龄52~86岁,ASAⅠ或Ⅱ级,疼痛数字评分（NRS）〉7分、病程〉1个月。随机分为椎旁组和静脉组,每组40例。分别予以椎旁神经阻滞复合NTP椎旁连续给药（45ml NTP＋195ml 0.9%氯化钠配泵,2ml/h）和静脉给药（每日静滴相同剂量NTP）。于治疗前、治疗后3h、出院时及出院后采用NRS评分评估疼痛程度,在治疗前后采用失眠严重程度指数（ISI）评估睡眠改善情况,并观察疗程结束时患者麻木及痛觉过敏的改善情况。结果与治疗前比较,治疗后3h及出院时两组患者NRS评分明显下降（P〈0.01）。出院4周随访,椎旁组NRS评分低于静脉组、麻木和痛敏治疗有效率高于静脉组;与治疗前比较,出院后4周两组ISI失眠评分均降低,但组间比较差异无统计学意义。两组均未出现明显不良反应。结论神经妥乐平联合椎旁给药治疗带状疱疹后神经痛的疗效优于静脉用药。

Objective To compare the efficacy of continuously paravertebral neurotropin（NTP）injection with that of intravenous administration on patients suffered from post-herpetic neuralgia.Methods Eighty patients diagnosed with post-herpetic neuralgia in the chest region（NRS〉7,duration〉1month,aged 52-86 years,ASA Ⅰ or Ⅱ）in our hospital from January 2015 to April 2016 were randomly divided into paravertebral group（n=40）and intravenous group（n=40）.For paravertebral group,a catheter was placed into the pain side of paravertebral space under the guiding of ultrasound.Mixed liquor of 45 ml NTP and 195 ml 0.9% NS was continuously injected into the paravertebral space with flow rate of 2ml/h.The same dose of NTP was intravenously injected in the intravenous group every day.Pain severity evaluation by score of NRS,sleep evaluation by insomnia severe index（ISI）,other subjective evaluation including numbness and hyperalgesia were carried out and side effects were observed before therapy,3 hafter therapy,at discharge and at 4-week follow-up.Results The NRS score decreased significantly in each group 3hafter therapy（P〈0.01）and when discharge without significance between two groups.At 4-week follow-up,pain reduction,numbness and hyperalgesia were improved in paravertebral group than those in intravenous group.Sleep quality was improved after therapy in both group without significant difference between the two groups.There were no serious complications in all patients.Conclusion Continuously paravertebral neurotropin infusion exhibits greater efficacy than intravenous NTP injection for pain management of post herpetic neuralgia.