糖皮质激素对椎旁阻滞治疗带状疱疹后神经痛疗效的影响

Combinatory effects of paravertebral block and steroids on post herpetic neuralgia

目的 观察糖皮质激素对椎旁阻滞治疗胸背部带状疱疹后遗神经痛（post-herpetic neuralgia,PHN）疗效的影响.方法 选择病变累及范围在T1～T12的顽固性PHN（带状疱疹后疼痛持续大于3个月且VAS大于7分）患者80例,随机数字表法分为神经妥乐平＋复方倍他米松注射液椎旁阻滞组（激素组）及神经妥乐平椎旁阻滞组（非激素组）（每组40例）.分别每2周行1次椎旁阻滞治疗,每位患者连续治疗4次,观察患者每次治疗后疼痛改善情况、疗程结束时.发痛发作频率及副作用.结果 两组患者每次治疗后疼痛较前一次均有明显缓解（P＜0.05）,疗程结束时两组患者疼痛症状较治疗前明显改善（P＜0.01）,部分爆发痛缓解明显,均未出现明显副作用;两组间比较,无论是各时间节点疼痛缓解还是爆发痛发作频率,差异均无统计学意义（P＞0.05）. 结论 椎旁阻滞时加入糖皮质激素治疗PHN疗效并不优于不加糖皮质激素阻滞.

Objective To compare the efficacy of paravertebral block with or without steroids on patients suffered from postherpetic neuralgia （PHN） in the chest region.Methods Eighty patients,diagnosed as PHN,were randomly divided into two groups receiving paravertebral block with and without steroid administration （n=40）.For each patient,nerve block was conducted every other week for four times.The score of VAS,frequency of pain outbreak,and therapy-related adverse effects were recorded after each treatment and at the end of the trial.Results Both paravertebral block with and without steroid improved the VAS score,and reduced the frequency of pain outbreak.But there was no significant differences between two groups.Conclusions Steroid did not promote the efficacy of paravertebral block in relieving PHN.