超声引导下椎旁神经阻滞联合皮下亚甲蓝注射治疗胸腹部带状疱疹后神经痛的效果分析

Clincal effect of ultrasound-guided paravertebral nerve block combined with subcutaneous injection of methylene blue on the patients with postherpetic neuralgia in the chest and abdomen

目的评估超声引导下椎旁神经阻滞联合皮下亚甲蓝注射治疗胸腹部带状疱疹后神经痛(postherpetic neuralgia, PHN)的疗效。方法选取2014年1月至2017年8月解放军总医院第一医学中心胸腹部PHN患者132例,随机分为两组,每组66例。所有患者均给予营养神经及改善微循环药物对症治疗,同时记录镇痛药物种类和剂量。治疗组行超声引导下椎旁神经阻滞联合皮下亚甲蓝注射治疗,对照组行超声引导下椎旁神经阻滞治疗。比较两组治疗后1 d、3d、7 d的VAS评分,15 d、30 d及90 d内疼痛控制在2~3分时镇痛药物服药种类及剂量减少情况,评估超声引导下椎旁神经阻滞联合皮下亚甲蓝注射治疗胸腹部PHN的疗效。结果两组在治疗前VAS评分差异无统计学意义,治疗后1周内VAS评分均较治疗前明显下降,差异有统计学意义(P<0.05),组内比较对照组治疗后1 d、3 d、7 d的VAS评分较治疗前均有明显下降,差异均有统计学意义(P<0.05)。治疗第1天治疗组VAS评分较对照组高,不除外治疗组皮下注射亚甲蓝后疼痛一过性加重,第7天治疗组VAS评分明显低于对照组。随访患者出院后15 d、30 d及90 d服药种类情况,治疗组(1.9±0.6、1.4±0.5、0.6±0.6)较对照组(2.0±0.4、1.6±0.5、1.3±0.6)有明显减少,差异均有统计学意义(P<0.05)。分别进行组内比较,治疗后服药种类较治疗前(治疗组为2.8±0.5,对照组为2.9±0.5)均有明显减少。结论超声引导下椎旁神经阻滞联合皮下亚甲蓝注射治疗较单一的超声引导下椎旁神经阻滞疗效确切,可明显改善疼痛症状,提高生活质量。

Objective To evaluate the efficacy of ultrasound-guided paravertebral nerve block combined with subcutaneous methylene blue injection in the treatment of postherpetic neuralgia(PHN) in the chest and abdomen. Methods One hundred and thirty-two patients with PHN in thorax and abdomen in The First Medical Center of Chinese PLA General Hospital from January 2014 to August 2017 were randomly divided into two groups, 66 cases in each group. All the patients were given nerve nutrition and microcirculation improvement drugs for symptomatic treatment, while recording the types and doses of analgesics. The treatment group was treated by ultrasound-guided paravertebral nerve block combined with subcutaneous methylene blue injection, and the control group was treated only by ultrasound-guided paravertebral nerve block. The pain VAS scores of 1, 3 and 7 days after treatment and the types reduction of analgesics when the pain was controlled at 2~3 within15 days, 30 days and 90 days were compared between the two groups. Results There was no significant difference in VAS score between the two groups before treatment, VAS score decreased significantly within one week after treatment(P < 0.05).Pain score of the control group decreased significantly after 1, 3 and 7 days of treatment compared with that before treatment(P < 0.05). Pain score of the treatment group was higher than that of the control group on the first day of treatment, with no exception of that the pain was temporarily aggravated after methylene blue injection in the treatment group. On the 7 th day, the pain score of the treatment group was significantly lower than that of the control group. After 15, 30 and 90 days of follow-up,the types of medication taken in the treatment group(1.9±0.6, 1.4±0.5, 0.6±0.6) were significantly lower than those in the control group(2.0 ± 0.4, 1.6 ± 0.5, 1.3 ± 0.6), respectively, with statistical significance(P < 0.05). Comparing within groups, the types of drugs taken after invasive treatment were significantly reduced compared with those before invasive treatment in both groups(2.8±0.5 vs. 2.9±0.5). Conclusions Ultrasound guided-paravertebral nerve block combined with subcutaneous methylene blue injection is more effective than single ultrasound guided paravertebral nerve block, which can obviously decrease the pain and improve the quality of life.