超声引导下脊神经阻滞和椎旁神经阻滞治疗带状疱疹后遗神经痛的临床效果

Clinical efficacy of ultrasound-guided spinal nerve block and paraverteral nerve block in treating postherpetic neuralgia

目的比较超声引导下脊神经阻滞(SNB)和椎旁神经阻滞(PVB)治疗带状疱疹后遗神经痛的临床效果。方法选取2020年2月至2022年12月中南大学湘雅医院疼痛门诊就诊的带状疱疹后遗神经痛患者52例,采用随机数字表法分成超声引导的SNB组和PVB组,每组各26例。SNB组患者接受超声引导的脊神经阻滞治疗;PVB组接受超声引导的椎旁神经阻滞治疗。观察治疗前、治疗后2周、治疗后1个月、治疗后3个月和治疗后6个月两组患者的视觉模拟量表(VAS)评分、36项简明健康状况调查问卷(SF-36)得分和总有效率,同时观察治疗期间并发症。结果SNB组患者治疗后1个月、3个月和6个月的总有效率均显著高于PVB组(均P<0.05)。治疗后两组患者各时间点VAS评分均较治疗前显著降低(均P<0.05);SNB组患者VAS评分在治疗后1个月、3个月和6个月各时点均低于PVB组,但差异无统计学意义(均P>0.05)。SNB组与PVB组患者神经阻滞治疗前躯体健康总得分(PCS)和心理健康总得分(MCS)差异无统计学意义(均P>0.05)。两组患者治疗后2周、治疗后1个月、治疗后3个月和治疗后6个月的MCS、PCS得分均较治疗前显著升高(均P<0.05),SNB组患者治疗后2周、治疗后1个月、3个月和6个月后MCS得分显著高于PVB组(均P<0.05),但两组间PCS得分比较差异无统计学意义(均P>0.05)。两组患者在随访期间均未出现与本研究治疗相关的严重并发症。结论超声引导下脊神经阻滞和椎旁神经阻滞均能安全有效地治疗带状疱疹后遗神经痛,超声引导下脊神经阻滞治疗带状疱疹后遗神经痛的临床效果优于椎旁神经阻滞。

Objective To compare the clinical efficacy of ultrasound-guided spinal nerve block(SNB)and paraverteral nerve block(PVB)in treating postherpetic neuralgia.Methods A total of 52 patients with postherpetic neuralgia who visited the Pain Clinic of the Xiangya Hospital,Central South University from February 2020 to December 2022 were selected and randomly divided into an ultrasound-guided SNB group and a PVB group using a random number table method,with 26 patients in each group.Patients in the SNB group received ultrasound-guided spinal nerve block therapy;The PVB group received ultrasound-guided paraverteral nerve block treatment.Visual Analog Scale(VAS)scores,36-Item Short Form Survey(SF-36)scores,and total effective rate were observed in two groups of patients before treatment,2 weeks after treatment,1 month after treatment,3 months after treatment,and 6 months after treatment.Complications during treatment were also observed.Results The total effective rates of SNB group patients at 1,3,and 6 months after treatment were significantly higher than those of PVB group(all P<0.05).After treatment,the VAS scores of both groups of patients at each time point were significantly reduced compared to before treatment(all P<0.05);The VAS scores of patients in the SNB group were lower than those in the PVB group at 1,3,and 6 months after treatment,but the difference was not statistically significant(all P>0.05).There was no statistically significant difference in Physical Component Summary(PCS)and Mental Component Summary(MCS)scores between SNB and PVB groups before nerve block treatment(all P>0.05).The MCS and PCS scores of the two groups of patients were significantly higher than before treatment at 2 weeks,1 month,3 months,and 6 months after treatment(all P<0.05).The MCS scores of the SNB group were significantly higher than those of the PVB group at 2 weeks,1 month,3 months,and 6 months after treatment(all P<0.05),but there was no statistically significant difference in PCS scores between the two groups(all P>0.05).Both groups of patients did not experience any serious complications related to the treatment in this study during the follow-up period.Conclusions Both ultrasound-guided spinal nerve block and paraverteral nerve block can safely and effectively treat postherpetic neuralgia.The clinical effect of ultrasound-guided spinal nerve block in treating postherpetic neuralgia is better than that of paraverteral nerve block.