CT引导下椎旁阿霉素注射治疗顽固性带状疱疹后神经痛短期及中期疗效的临床观察

Short and mid-term effectiveness of paravertebral adriamycin injection under CT guidance on intractable postherpetic neuralgia

目的:观察CT引导下椎旁阿霉素注射治疗带状疱疹后神经痛(postherpetic neuralgia,PHN)患者短期及中期的临床疗效。方法:纳入四川大学华西医院麻醉科疼痛病房2010年1月至2012年5月68例对药物、神经阻滞等治疗方法效果不佳而采用CT引导下椎旁阿霉素注射治疗带状疱疹后神经痛的患者。观察指标:治疗前视觉模拟评分(Visual Analogue Score,VAS)、治疗后(即出院时:CT引导下阿霉素椎旁神经注射治疗后1~2 d)和术后1年的最轻、最重及平均VAS评分;出院时及术后1年疼痛缓解率;治疗前、后及术后1年生活质量评定采用生活质量量表(Quality of Life Score,QLS),主要包括5个方面:起居(如起床、穿衣、洗漱)、饮食、一般活动(如站、坐、行)、睡眠、工作及社会活动。分为4个等级:完全自如,小部分受限,大部分受限,完全受限;治疗后的并发症。结果:患者治疗后(出院时)VAS评分[平均(3.5±1.5),最轻(2.1±0.9),最重(4.5±1.4)]明显低于治疗前VAS评分[平均(7.9±1.3),最轻(6.5±1.7),最重(9.2±1.1);P<0.05],出院1年后的VAS评分[平均(2.2±1.8),最轻(1.5±0.8),最重(3.2±1.6)]明显低于治疗前及治疗后(出院时)的VAS评分(P<0.05)。治疗后(出院时)的疼痛缓解率为(68±23)%;1年后疼痛缓解率(81±22)%明显高于治疗后(出院时)的疼痛缓解率(P<0.05);治疗后(出院时)QLS与治疗前比较有明显改善(P<0.05);出院1年后的QLS与治疗后及治疗前比较有明显改善(P<0.05)。68例患者无明显并发症。结论:CT引导下椎旁阿霉素注射治疗顽固性带状疱疹后神经痛可有效地缓解病人的疼痛,改善睡眠,提高病人的生活质量,同时未见明显并发症。CT引导下椎旁阿霉素注射治疗顽固性带状疱疹后神经痛安全有效。

Objective: To determine the short and mid-term effect of paravertebral adriamycin injection under CT guidance on intractable postherpetic neuralgia(PHN).Methods: From January 2010 to May 2012, 68 patients with intractable PHN receiving paravertebral adriamycin injection under CT guidance were enrolled. The outcome included the Quality of Life Score(QLS), Visual Analogue Score(VAS)(average, the worst and the least VAS), pain relief rate at the time before and after the injection, and 1 year after discharge.Results: Lower VAS was observed after the injection than that before the injection [(3.5±1.5) vs(7.9±1.3) on average;(2.1±0.9) vs(6.5±1.7) at least and(4.5±1.4) vs(9.2±1.1) at worst, P<0.05]. Lower VAS at 1 year after discharge was found than that before the injection [(2.2±1.8) vs(7.9±1.3) on average;(1.5±0.8) vs(6.5±1.7) at least;(3.2±1.6) vs(9.2±1.1) at worst ] and that after the injection [(3.5±1.5) vs(2.2±1.8) on average;(1.5±0.8) vs(2.1±0.9) at least and(3.2±1.6) vs(4.5±1.4) at worst, P<0.05]. The pain relief rate after the injection was(68±23)%. The pain relief rate at 1 year after discharge(81±22)% was higher than that at discharge(68±23)%(P<0.05). The quality of life evaluation index scale after the injection(daily life, diet, general activities, sleep, work and social activities) was significantly improved than that before the injection [(10.1±2.2) vs(14.2±1.9), P<0.05]. The quality of life evaluation index scale at 1 year after discharge was significantly improved than that before the injection [(7.0±2.1) vs(14.2±1.9)] and that after the injection [(7.0±2.1) vs(10.1±2.2), P<0.05]. No complication was observed when the patients were discharged and 1 year after discharge. Conclusion: Paravertebral adriamycin injection under CT guidance for intractable PHN can effectively relieve the patient's pain, improve the quality of sleep and life without obvious complications. It is safe and effective for intractable PHN.