普瑞巴林联合超声引导下胸椎旁神经阻滞治疗老年带状疱疹后神经痛的临床观察

Clinical observation of pregabalin combined with ultrasound-guided thoracic paravertebral nerve block in the treatment of elderly patients with postherpetic neuralgia

目的观察普瑞巴林和超声引导下胸椎旁神经阻滞联合治疗老年带状疱疹后神经痛的疗效,为治疗该病症提供方法。方法选择2020年10月—2022年10月于北京积水潭医院就诊的老年带状疱疹后神经痛患者90例,按照数字表法随机分为对照组(普瑞巴林口服,45例)和联合组(普瑞巴林口服+超声引导下胸椎旁神经阻滞,45例)。采用视觉模拟评分法(VAS)、匹兹堡睡眠质量指数(PSQI)分别评估并比较2组患者治疗前及治疗1、2、4、8周的疼痛,以及治疗前及治疗4、8周的睡眠质量;检测并比较2组患者治疗前及治疗8周后血液疼痛介质[P物质(SP)、β-内啡肽(β-EP)、神经降压肽(NT)]水平;统计并比较2组普瑞巴林用药量、加用羟考酮例数及药物不良反应。结果联合组治疗1、2、4、8周的VAS评分和治疗4、8周的PSQI评分均低于同期对照组(P<0.05);治疗8周,联合组血SP水平低于对照组(P<0.05),而血β-EP、NT水平高于对照组(P<0.05);治疗8周,联合组普瑞巴林日用药量、加用羟考酮例数均少于对照组(P<0.05);联合组不良反应发生率低于对照组(17.78%vs 37.78%,P<0.05)。结论采用普瑞巴林联合超声引导下胸椎旁神经阻滞治疗老年带状疱疹后神经痛,镇痛效果良好,可调节疼痛介质分泌水平,提高患者睡眠质量,还可减少普瑞巴林用药量及补救镇痛,减少药物不良反应。

Objective To explore the efficacy of pregabalin combined with ultrasound-guided thoracic paravertebral nerve block in the treatment of elderly patients with postherpetic neuralgia,and provide a method for the disease treatment.Methods 90 elderly patients with postherpetic neuralgia admitted to Beijing Jishuitan Hospital from October 2020 to October 2022 were selected and divided into control group(oral administration of pregabalin,45 cases)and combined group(oral administration of pregabalin+ultrasound-guided thoracic paravertebral nerve block,45 cases)by simply random number table method.Visual Analogue Scale(VAS)was used to compare the pain level of the two groups before treatment and at 1,2,4 and 8 weeks of treatment.The Pittsburgh Sleep Quality Index(PSQI)was used to evaluate sleep quality of the two groups before treatment and at 4 and 8 weeks of treatment.The levels of pain mediators[substance P(SP),β-endorphin(β-EP),neurotensin(NT)]in blood of the two groups were detected and compared before treatment and 8 weeks after treatment.The dosage of pregabalin,number of cases with additional oxycodone and adverse drug reactions were counted and the differences between the two groups were compared.Results VAS scores at 1,2,4 and 8 weeks of treatment and PSQI scores at 4 and 8 weeks of treatment of the combined group were lower than those of the control group(P<0.05).After 8 weeks of treatment,the blood SP level of the combined group was lower than that of the control group(P<0.05),while the bloodβ-EP and NT levels were higher than that of the control group(P<0.05).After 8 weeks of treatment,the daily dose of pregabalin and number of cases with additional oxycodone of the combined group were lower than those of the control group(P<0.05).The incidence of adverse reactions in the combined group was lower than that in the control group(17.78%vs 37.78%,P<0.05).Conclusion For elderly patients with postherpetic neuralgia,the combination of pregabalin and ultrasound-guided thoracic paravertebral nerve block can achieve good analgesic effect.It can regulate the secretion level of pain mediators,improve patient s sleep quality,reduce the dosage of pregabalin and relieve pain,and reduce adverse drug reactions.