氨酚曲马多联合超声引导下椎旁神经阻滞治疗带状疱疹后神经痛患者的临床研究

Clinical Study of Paracetamol and Tramadol Hydrochloride Combined with Ultrasound-Guided Paravertebral Nerve Block in the Treatment of Patients with Postherpetic Neuralgia

目的:探讨氨酚曲马多联合超声引导下椎旁神经阻滞对带状疱疹后神经痛(PHN)患者的治疗效果。方法:选取2022年10月~2023年10月期间某院收治的150例PHN患者作为研究对象,根据简单随机分组法分为对照组和观察组,每组75例。对照组患者给予超声引导下椎旁神经阻滞治疗,观察组患者在对照组治疗基础上加用氨酚曲马多片。比较两组患者临床疗效、疼痛情况[视觉模拟评分(VAS)]、睡眠质量[匹兹堡睡眠质量指数量表(PSQI)]、血清疼痛介质[神经降压肽(NT)、β-内啡肽(β-EP)和P物质(SP)]水平、并发症及不良反应发生情况。结果:治疗后,观察组患者治疗总有效率(84.00%)高于对照组(62.67%,P<0.05);两组患者VAS评分、PSQI评分和SP水平均降低,且观察组低于对照组(P<0.05);血清NT、β-EP水平均升高,且观察组高于对照组(P<0.05)。治疗期间,两组患者均未出现由穿刺引起的神经损伤、感染、气胸、穿刺针误入血管、氨酚曲马多成瘾性等并发症;观察组患者不良反应总发生率(36.00%)低于对照组(70.67%,P<0.05)。结论:氨酚曲马多联合超声引导下椎旁神经阻滞治疗PHN患者临床疗效较佳,可有效改善患者疼痛和睡眠质量,调节疼痛相关介质水平,且能减少不良反应的发生。

Objective:To explore the therapeutic effect of paracetamol and tramadol hydrochloride combined with ultrasound-guided paravertebral nerve block therapy on patients with postherpetic neuralgia(PHN).Methods:A total of 150 patients with PHN treated in the hospital from October 2022 to October 2023 were selected and divided into the control group and the observation group using the simple random grouping method,with 75 patients in each group.The patients in the control group received ultrasound-guided paravertebral nerve block,whereas the patients in the observation group were treated with paracetamol and tramadol hydrochloride tablets on the basis of the control group.The clinical efficacy,pain status[visual analogue scale(VAS)],sleep quality[Pittsburgh sleep quality index(PSQI)],serum pain mediators[neurotensin(NT),β-endorphin(β-EP)and substance P(SP)],complications and adverse reactions were compared between the two groups.Results:After treatment,the overall response rate in the observation group(84.00%)significantly higher than in the control group(62.67%,P<0.05).The VAS scores,PSQI scores and SP level were decreased in both groups,and the observation group were lower than those in the control group(P<0.05).The levels of serum NT andβ-EP were increased in both groups,and the observation group were higher than those in the control group(P<0.05).During the treatment period,no complications resulting from the procedure,such as nerve injury,infection,pneumothorax,needle puncture into blood vessels,and addiction to paracetamol and tramadol hydrochloride,were reported in either group.The overall incidence rate of adverse reactions in the observation group(36.00%)was lower than in the control group(70.67%,P<0.05).Conclusion:Paracetamol and tramadol hydrochloride combined with ultrasound-guided paravertebral nerve block demonstrated positive clinical efficacy in the treatment of PHN patients.This treatment can effectively improve pain and sleep quality,regulate pain-related mediator levels,and reduce the occurrence of adverse reactions.