中医多模式镇痛治疗带状疱疹后遗神经痛的疗效及对预后的影响

Efficacy of Multimodal Analgesia of Traditional Chinese Medicine for Postherpetic Neuralgia and Its Influence on Prognosis

目的探讨中医多模式镇痛应用于带状疱疹后遗神经痛(Post-herpetic neuralgia,PHN)的疗效及对预后的影响。方法选取2018年5月—2020年5月期间于广州中医药大学第三附属医院治疗的PHN患者88例,按随机数字表法分为对照组(常规西医治疗44例)和研究组(常规西医治疗联合中医多模式镇痛治疗44例)。两组患者均治疗1个月后,观察比较两组患者临床疗效,治疗前后血清P物质(Serum substance P,SP)、神经激肽-1(Neurokinin-1,NK-1)水平以及肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白介素-6(Interleukin-6,IL-6)、C反应蛋白(c-reactive protein,CRP)等炎性因子水平,治疗前后比较数字疼痛强度量表(numeric rating scales,NRS)评分、匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评分与生活质量综合评定量表(Generic quality of life inventory-74,GQOLI-74)评分,记录不良反应发生率及复发率。结果治疗后研究组总有效率92.68%(38/41)明显高于对照组71.43%(30/42),差异有统计学意义(P<0.05)。治疗后两组患者血清SP、NK-1水平均较治疗前明显降低,差异有统计学意义(P<0.05);且研究组治疗后血清SP、NK-1水平均较对照组明显降低,差异均有统计学意义(P<0.05)。治疗后两组患者血清TNF-α、IL-6、CRP水平均较治疗前降低,差异均有统计学意义(P<0.05);且研究组治疗后血清TNF-α、IL-6、CRP水平均较对照组明显降低,差异有统计学意义(P<0.05)。治疗后两组患者RNS、PSQI评分均较治疗前降低,GQOLI-74评分均较治疗前升高,差异有统计学意义(P<0.05),且研究组治疗后RNS、PSQI评分均较对照组明显降低,GQOLI-74评分较对照组明显升高,差异均有统计学意义(P<0.05)。治疗期间,研究组不良反应发生率为14.63%(6/41),对照组不良反应发生率为11.90%(5/42),两组比较,差异无统计学意义(P>0.05)。随访6个月,研究组复发率2.44%(1/41)低于对照组16.67%(7/42),两组比较,差异有统计学意义(P<0.05)。结论中医多模式镇痛治疗PHN疗效更为显著,可有效减轻患者疼痛症状,改善其睡眠与生活质量,下调炎症因子水平,降低疾病再发风险,且安全性高。

Objective To explore the effect of traditional Chinese medicine multimodal analgesia on post-herpetic neuralgia(PHN)and its influence on the prognosis.Methods 88 cases of PHN patients who were treated in the Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from May 2018 to May 2020 were selected as the research object and divided into a control group(44 cases treated by conventional western medicine)and a study group(44 cases treated by conventional western medicine combined with traditional Chinese medicine multimodal analgesia),according to the random number table.Both groups were treated for 1 month.The treatment effects of the two groups,Serum substance P(SP),neurokinin-1(NK-1)levels and tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)levels before and after treatment were compared.Numeric rating scales(NRS)score,Pittsburgh sleep quality index(PSQI)score and comprehensive quality of life inventory-74(GQOLI-74)score before and after treatment were compared.Adverse reaction incidence and recurrence rate before and after treatment were compared.Results After treatment,the total effective rate of the study group was 92.68%(38/41)was significantly higher than that of the control group 71.43%(30/42),the difference was statistically significant(P<0.05).After treatment,the serum SP and NK-1 levels of the two groups of patients were significantly lower than those before treatment,and the difference was statistically significant(P<0.05);and the serum SP and NK-1 levels of the study group after treatment were significantly lower than those of the control group.All were statistically significant(P<0.05).After treatment,the serum TNF-α,IL-6,and CRP levels of the two groups of patients were lower than before treatment,and the difference was statistically significant(P<0.05);and the study group’s serum TNF-α,IL-6,and CRP levels after treatment All were significantly lower than the control group,and the difference was statistically significant(P<0.05).After treatment,the RNS and PSQI scores of the two groups of patients were lower than before treatment,and the GQOLI-74 scores were higher than before treatment,and the difference was statistically significant(P<0.05).After treatment,the RNS and PSQI scores of the study group were both higher than those of the control group.The score of GQOLI-74 was significantly higher than that of the control group,and the difference was statistically significant(P<0.05).During the treatment period,the incidence of adverse reactions in the study group was 14.63%(6/41),and the incidence of adverse reactions in the control group was 11.90%(5/42).There was no significant difference between the two groups(P>0.05).After 6 months of follow-up,the recurrence rate of2.44%(1/41)in the study group was lower than 16.67%(7/42)in the control group,and the difference was statistically significant(P<0.05).Conclusion The multi-modal analgesia of traditional Chinese medicine has a good effect in the treatment of PHN.It can effectively reduce the pain symptoms of patients,improve their sleep and quality of life,lower the level of inflammatory factors,reduce the risk of disease recurrence,and is safe.