神经阻滞预防带状疱疹后神经痛及其高危因素分析

Prevention of Postherpetic Neuralgia by Nerve Block and Analysis of Risk Factors

目的探讨神经阻滞对治疗带状疱疹(HZ)和预防带状疱疹后神经痛(PHN)的效果,探寻影响PHN发生的因素.方法 2015年1月至2016年9月昆明医科大学第一附属医院疼痛科收治的首次发病且未经任何治疗的急性期HZ患者80例.随机分配到病例组(神经阻滞+常规内科治疗)40例,和对照组(常规内科治疗)40例.对比2组带状疱症后神经痛发生率,分析年龄、性别、疱疹部位、前驱性疼痛、初始疼痛程度、结痂时间、和治疗1周时的疼痛缓解率等,与PHN发生率的相关关系.结果病例组有4例(10.0%)发生PHN,较对照组19例(47.5%)显著降低(P<0.001).病例组住院天数减少(7.43±1.80)d vs(12.90±2.36)d,P<0.001,结痂时间缩短(6.33±0.86)d vs(7.15±0.66)d,P<0.001.高龄(OR:13.03,95%CI:2.73~62.34)、发病起始的VAS评分(OR:8.24,95%CI:1.62~41.96)和结痂时间延长(OR:17.99,95%CI:2.14~151.43),是PHN的危险因素,显著增加PHN发生率.治疗1周时的VAS缓解率(OR<0.000,95%CI:0.000~0.001),是PHN的保护因素,与PHN的发生呈负相关.结论高龄和发病时疼痛严重的患者,应注意预防PHN.神经阻滞有助于减少HZ患者住院天数,缩短结痂时间,降低PHN发生率.

Objective To investigate the effect of nerve block on the treatment of herpes zoster （HZ ） andprevention of postherpetic neuralgia （PHN ）, and to explore the factors that affect the occurrence of PHN.Methods From january 2015 to September 2016 in our hospital 80 acute HZ patients for the first time in thetreatment of pain,were randomly assigned to the case group （nerve block ＋ conventional medical treatment ） 40cases, and the control group （conventional medical treatment ） 40 cases. The incidence of neuralgia in the twogroups was analyzed, and the relationship between the age, sex, herpes, prodromal pain, initial pain, scabtime, pain relief rate and PHN. Results PHN occurred in 4 cases （10.0%） in the case group and 19 cases（ 47.5% ） in the control group （ 〈0.001）. （ 6.33 ± 0.86 days vs. 7.15 ± 0.66 days, 〈0.001） . The numberof hospital days decreased （7.43 ±1.80 days vs. 12.90 ± 2.36 days, 〈0.001） . Ageing （OR： 8.24, 95% CI：1.62-41.96） and prolonged crusting time （OR： 17.99, 95% CI： 2.14- 151.43）, are risk factors for PHN,significantly increased the incidence of PHN. The VAS remission rate after 1 week （OR 〈0.000, 95% CI：0.000-0.001） was a protective factor for PHN and was negatively correlated with PHN. Conclusions Aging andonset of severe pain in patients should pay attention to the prevention of PHN. Nerve block helps to reduce the number of hospital stay in HZ patients,shorten the scab time,and reduce the incidence of PHN.