椎旁阻滞联合臭氧自体血回输治疗老年带状疱疹疗效观察

EFFICACY OF THORACIC PARAVERTEBRAL BLOCKADE COMBINED WITH OZONE THERAPY FOR TREATMENT OF ACUTE HERPES ZOSTER PAIN IN AGED PATIENTS

目的:观察胸椎旁阻滞联合臭氧自体血回输治疗老年胸段带状疱疹急性期疼痛的疗效、皮损持续时间、带状疱疹后神经痛(postherpetic neuralgia,PHN)发生率。方法:100名大于60岁的急性胸段带状疱疹患者,随机分为试验组(n=50)及对照组(n=50),两组均行超声引导下胸椎旁阻滞,试验组同时接受臭氧自体血回输。记录治疗前、治疗后1、2、3、4、6、8、12周视觉模拟评分(visual analogue scale,VAS)及情绪评分(emotional scale,ES)。记录疼痛缓解、皮损愈合时间及PHN发生率。结果:两组治疗后各时间点VAS及ES均显著降低。试验组前4周VAS及前8周ES显著降低,疼痛和皮损持续时间显著缩短(P=0.011,P<0.001)。在第3个月时试验组PHN发生率显著降低(P=0.012)。结论:老年急性胸段带状疱疹病程中,早期椎旁阻滞联合臭氧自体血回输是一种安全有效的治疗方式。

Objective： The aim of this study was to evaluate the efficacy of ultrasound- guided thoracic paravertebral blockade combined with ozone therapy in acute thoracic herpes zoster pain, eruptive duration, and the incidence of postherpetic neuralgia （PHN）. Methods： 100 patients over 60 years of age with acute thoracic herpetic eruption were randomly assigned to experimental group （n=50） and control group （n=50）. All the patients received an Ultrasound-Guided Thoracic paravertebral block and experimental group received an ozone therapy additionally. Visual analogue scale （VAS） and emotional scale （ES） were evaluated before and after treatment at different time points （basal, 1 w, 2 w, 3 w, 4 w, 6 w, 8 w and 12 w）. Time to pain resolution, healing of the skin eruption, and incidence of PHN were recorded. Results： VAS and ES in both groups were decreased significantly at different time points after treatment compared with basal. Experimental group showed significantly lower VAS and ES at the first 4 and 8 weeks respectively. Significantly shorter duration of pain and herpetic eruption was noticed in the experimental group vs. controlled group （P = 0.01 l, P 〈 0.001）. A significantly lower incidence of PHN was noted in experimental group at 3 months （P = 0.012）. Conclusion： Early Ultrasound-Guided Thoracic Paravertebral Blockade combined with ozone therapy in the course of acute thoracic herpes zoster can be a safe and effective treatment modality.