胸椎旁阻滞联合高能量激光治疗胸背部带状疱疹后神经痛的疗效观察

EFFICACY OF THORACIC PARAVERTEBRAL NERVE BLOCK COMBINED WITH HIGH INTENSITY LASER THERAPY ON POSTHERPETIC NEURALGIA

目的:观察超声引导下胸椎旁神经阻滞联合高能量激光(high intensity laser therapy,HILT)对胸背部带状疱疹后神经痛(postherpetic neuralgia,PHN)的疗效。方法:选择2017年3月至2018年3月于我科住院治疗的100例确诊为胸背部带状疱疹后神经痛的病人为研究对象,随机分A组(对照组)和B组(试验组),每组50例。两组病人均给予营养神经和止痛药物及超声引导下胸椎旁神经阻滞治疗;在此基础上,B组病人每日行高能量激光(high intensity laser therapy,HILT)治疗,A组病人接受假激光治疗。比较两组病人治疗前后视觉模拟疼痛评分(visual analogue scale,VAS)和睡眠质量评分(self-rating scale of sleep,SRSS)的差异,治疗总体有效率,治疗期间平均每日盐酸曲马多使用量以及不良反应发生情况。结果:与治疗前比较,两组病人治疗后1周(1 w)、1月(1 m)、2月(2 m)和3月(3 m)的VAS评分和SRSS评分均明显降低(P<0.05);B组病人治疗后各时间段VAS评分和SRSS评分与A组比较,差异具有统计学意义(P<0.05);B组总体有效率明显高于A组(P<0.05);B组治疗期间平均每日盐酸曲马多使用量明显低于A组(P<0.05);两组不良反应无显著差异(P>0.05)。结论:超声引导下胸椎旁阻滞联合高能量激光治疗胸背部带状疱疹后神经痛疗效显著,值得临床推广应用。

Objective:To evaluate the efficacy of ultrasound-guided thoracic paravertebral blockade combined with high intensity laser therapy(HILT)on patients with thoracic postherpetic neuralgia(PHN).Methods:One hundred patients diagnosed with thoracic postherpetic neuralgia were randomly assigned to the control(group A,n=50)and the test groups(group B,n=50).Both groups were treated with neural nutrients,analgesics and thoracic paravertebral blockade;high intensity laser therapy(HILT)was applied on the basis of drμg therapy and blockade treatment in group B whereas the other 50 patients in the control group received sham laser therapy.The curative effect was evaluated with visual analogue scale(VAS)and self-rating scale of sleep(SRSS)at the time of pre-treatment,1 week,and 1,2and 3 months after the treatment.The daily consumption of tramadol hydrochloride and adverse effects were also recorded.Results:VAS and SRSS in both groups decreased significantly at different time points after the treatment compared with the baseline(P<0.05).Group B showed significantly lower VAS and SRSS after treatment compared to group A(P<0.05)and the overall efficacy was significantly higher in group B(P<0.05).The daily consumption of tramadol hydrochloride in group B was significantly lower than that in group A(P<0.05).The adverse effects had no significant difference in both groups.Conclusion:Thoracic paravertebral nerve block combined with high intensity laser therapy(HILT)can effectively alleviate pain in patients with thoracic PHN,and is worthy of being widely applied in clinic.