早期多模式镇痛治疗带状疱疹及预防带状疱疹后遗神经痛57例

Multimodality Analgesic Therapy on 57 Cases of Early Stage of Herpes Zoster for Preventing the Post-herpetic Neuralgia

目的探讨早期使用多模式镇痛综合治疗在带状疱疹中的疗效及其预防带状疱疹后遗神经痛(PHN)的有效性。方法纳入于葛洲坝集团中心医院疼痛科、皮肤科和神经内科就诊的带状疱疹患者120例,为首次发病且病程≤7 d。将患者分成对照组(63例)和治疗组(57例),对照组给予带状疱疹常规治疗:甲钴胺(500μg,肌内注射,每天1次)、维生素B_1(100 mg,肌内注射,每天1次)、维生素B_6(100 mg,肌内注射,每天1次)和抗病毒药物。治疗组给予多模式镇痛(口服镇痛药物,局部浸润麻醉和神经阻滞)联合带状疱疹常规方法的综合治疗。使用疼痛视觉模拟评分(VAS)对两组患者于治疗前和治疗4周后的疼痛程度和临床疗效进行评估,并对所有患者进行随访,观察病程第8周和第12周时带状疱疹后遗神经痛的发生率。结果治疗组患者神经疼痛减轻程度明显优于对照组(P<0.01);病程第4周时,治疗组患者的疼痛完全缓解率比对照组高(93.0%和49.2%,P<0.01)。在病程第8周和第12周时,对照组PHN的发生率分别为17.5%和11.1%,而治疗组均为0(P<0.01)。结论合理运用多模式镇痛治疗早期带状疱疹,能在病情初期有效缓解带状疱疹疼痛,并且能有效预防PHN的发生。

Objective To explore the efficacy of the multimodality analgesic therapy in early stage of herpes zoster,and the effectiveness for preventing the post-herpetic neuralgia.Methods A total of 120 patients diagnosed with herpeszoster whose clinical course was less than 7 days in clinic of Dermatology,Pain Medicine and Neurology of Gezhouba Central Hospital,were recuited in this study.Patients were divided into control group and treatment group,63 patients in control group received conventional treatment for herpes zoster,and 57 patients in treatment group were given multimodality analgesic therapy combined with conventional treatment.The visual analogue scale(VAS)was evaluated before and 4 weeks after treatment,and the efficiency of treatment for two groups was calculated.Patients were followed up through 8 and 12 weeks to explore the incidence and outcome of post-herpetic neuralgia.Results VAS scores of treatment group was statistically significant lower than control group after 4 weeks treatment(P<0.01);The total effective rate for neuralgia in treatment group was higher than control group(93.0%vs 49.2%,P<0.01),and the incidence of post-herpetic neuralgia was lower in treatment group after 8 and 12 weeks treatment(P<0.01).Conclusion Multimodality analgesic therapy can relieve the neuralgia in early stage of herpes zoster,also can develop a favorable long term outcome in post-herpetic neuralgia.