连续硬膜外阻滞联合皮内注射治疗带状疱疹后神经痛的短期疗效观察

Observation of Short-term Efficacy of Continuous Epidural Block Combined with Intradermal Injection in the Treatment of Postherpetic Neuralgia

目的探究连续硬膜外阻滞联合皮内注射治疗带状疱疹后神经痛(Postherpetic Neuralgia,PHN)的短期疗效及其临床应用价值。方法该研究选取2020年10月—2021年6月该院收治的PHN患者共60例作为研究对象,随机分成A、B、C、D 4组,每组15例。D组患者直接予以口服药物治疗,其他患者按照不同分组分别进行连续硬膜外阻滞、皮内注射或二者联合治疗。对比4组疼痛情况、视觉模拟评分(VAS评分)、生活质量得分评估(SF-36)、总有效率及不良反应发生率。结果C组在术后1天的静息及运动VAS评分低于A组和D组,棉签诱导VAS评分低于其他3组(P<0.05),术后1周及术后2周静息、运动及棉签诱导VAS评分低于B组和D组(P<0.05)。4组SF-36评分差异有统计学意义(P<0.05)。总有效率比较,A组100%、B组87%、C组100%、D组87%差异有统计学意义(χ^(2)=16.518,P<0.05)。不良反应发生率比较,A组33%、B组20%、C组13%、D组67%差异有统计学意义(χ^(2)=11.400,P<0.05)。结论连续硬膜外阻滞联合皮内注射治疗带状疱疹后神经痛能够显著减轻患者疼痛,提高患者生命质量,有效率高,不良反应少且较为安全,值得临床推广。

Objective To investigate the short-term efficacy and clinical value of continuous epidural block combined with intradermal injection in the treatment of postherpetic neuralgia(PHN).Methods A total of 60 PHN patients admitted to our hospital from October 2020 to June 2021 were selected as the research subjects.They were randomly divided into four groups,A,B,C,and D,with 15 cases in each group.Patients in group D were directly treated with oral drugs.Other patients were treated with continuous epidural block,intradermal injection or a combination of the two according to different groups.The pain,visual analogue scale(VAS score),quality of life score assessment(SF-36),total effective rate and incidence of adverse reactions were compared among the 4 groups.Results The resting and exercise VAS scores in group C were lower than those in groups A and D,and the VAS scores induced by cotton swabs were lower than those in the other three groups(P<0.05).Rest,exercise and cotton swab-induced VAS scores were lower in groups B and D at 1 week and 2 weeks after operation(P<0.05).There were significant differences in SF-36 scores among the four groups(P<0.05).The total effective rate was 100% in group A,87% in group B,100% in group C,and 87% in group D,and the difference was statistically significant(χ^(2)=16.518,P<0.05).The incidence of adverse reactions was significantly different in group A,33%,group B,20%,group C,13%,and group D,67%(χ^(2)=11.400,P<0.05).Conclusion Continuous epidural block combined with intradermal injection in the treatment of postherpetic neuralgia can significantly reduce the pain of patients and improve the quality of life of patients,with high effective rate,few adverse reactions and relatively safe.It is worthy of clinical promotion.