围刺联合穴位注射对带状疱疹急性期疼痛的神经保护作用

Neuroprotective effect of surround needling combined with acupoint injection on acute herpetic neuralgia

目的:探讨围刺联合穴位注射对带状疱疹急性期疼痛(AHN)的疗效及作用机制。方法:99例T_6～T_(10)节段AHN患者随机分为3组,每组33例,其中围刺组脱落2例,穴位注射组脱落4例,联合组脱落3例。各组患者均口服盐酸伐昔洛韦片,每次0.3 g,每日2次,共10 d。围刺组穴取疱疹周围阿是穴,斜刺后予连续波耐受量电刺激20 min;穴位注射组取穴同上,注射甲钴胺注射液配伍利多卡因注射液;联合组围刺后再予穴位注射。各组均每日1次,14次为一疗程,治疗1个疗程。比较各组治疗后皮肤愈合情况(止疱、结痂、脱痂时间),观察各组治疗前后疼痛评分、疼痛面积和生活质量评分,检测各组患者治疗前后局部疱液中神经元特异性烯醇化酶(NSE)、P物质(SP)和降钙素基因相关肽(CGRP)的含量。结果:联合组止疱、结痂、脱痂时间均早于其他两组(均P<0.05)。各组患者治疗后疼痛评分、疼痛面积均较治疗前明显减少,生活质量评分较治疗前明显提高(均P<0.05),联合组疼痛评分、生活质量评分较其他两组改善更明显(均P<0.05)。治疗后各组患者局部疱液中NSE、SP和CGRP含量较治疗前均明显下降(均P<0.05),联合组各指标较其他两组下降更显著(均P<0.05)。结论:围刺和穴位注射均对AHN有辅助疗效,两者结合疗效更优,皮肤愈合迅速,镇痛显著,局部NSE、SP和CGRP的含量下降明显,其作用机制在于发挥神经保护作用。

Objectives To explore the effect and mechanism of surround needling combined with acupoint injection on acute herpetic neuralgia(AHN). Methods Ninety-nine patients with T6-T10 segment AHN were randomly divided into 3 groups, 33 cases in each group, including 2 cases dropped off in the surround needling group, 4 cases dropped off in the acupoint injection group, and 3 cases dropped off in the combined group. Oral valacyclovir was given in each group, 0.3 g each time, 2 times a day for 10 days. Oblique insertion of needle used at ashi points around the herpes in the surround needling group, and continuous wave was stimulated to tolerance for 20 min;the same acupoints were selected as the surround needling group, stimulated with the mixture injection of mecobalamin and lidocaine in the acupoint injection group;After the surround needling, acupoint injection was performed in the combined group. The treatment was given once a day, 14 times for a course, and one course was needed in all groups. The skin healing conditions(blistering, crusting, and dislocation time) of each group were compared after treatment. The pain scores, pain area and quality of life scores in each group were observed before and after treatment. The levels of neuron specific enolase(NSE), substance P(SP) and calcitonin gene-related peptide(CGRP) in the local blister fluid were measured before and after treatment in all groups. Results The blistering,crusting and dislocation time in the combined group were earlier than the other two groups(all P<0.05). The pain score and pain area in the each group were significantly lower than those before treatment, and the quality of life score was significantly higher than that before treatment(all P<0.05). The improvements of pain score and quality of life score in the combined group were more obvious than the other two groups(all P<0.05). After treatment, the levels of NSE, SP and CGRP in the local blister fluid in each groups were significantly lower than those before treatment(all P<0.05). The indexes in the combined group were significantly lower than those in the other two groups(all P<0.05). Conclusion Both surround needling and acupoint injection have an adjuvant effect on AHN. The combination of the two is better, the skin is healed quickly, the analgesia is significant, and the contents of local NSE, SP and CGRP are significantly decreased. The mechanism of action is to exert neuroprotective effects.