三种神经阻滞方法治疗胸部带状疱疹后神经痛有效性的临床观察

Efficacy of three kinds of nerve block in the treatment of thoracic post herpetic neuralgia

目的：观察硬膜外神经阻滞、CT引导下背根神经节阻滞、外周肋间神经阻滞治疗带状疱疹后神经痛（post herpetic neuralgia，PHN）的临床有效性，选择最佳治疗方法。方法选择2013~2015年我科收治的PHN患者80例，按照随机数字表法分为4组，每组20例。 A组为对照组，采用单纯药物治疗；B组为硬膜外神经阻滞组；C组为背根神经节（dor-sal root ganglion，DRG）神经阻滞组；D组为肋间神经阻滞组。 B、C、D组分别在药物治疗基础上选择相应的有创治疗方法注射药物。观察患者治疗前1d、治疗后1周、4周、8周、12周的疼痛视觉模拟评分（VAS评分），并记录加巴喷丁及盐酸曲马多缓释片的药物使用量。结果治疗后4组患者VAS评分均明显降低，治疗有效。组间两两比较，有创治疗B、C、D组较A组治疗后VAS评分显著下降（P<0.05），VAS评分由低到高依次为背根神经节阻滞组、硬膜外神经阻滞组、肋间神经阻滞组；B、C、D组在治疗期间盐酸曲马多及加巴喷丁药物使用量较A组明显减少（P<0.05），日均药物使用量由少到多依次为背根神经节阻滞组、硬膜外神经阻滞组、肋间神经阻滞组。结论 CT引导下背根神经节阻滞对缓解PHN患者神经病理性疼痛效果显著。

Objective To observe the clinical efficacy of epidural nerve block,CT guided dorsal root ganglion block,pe-ripheral intercostal nerve block in the treatment of post herpetic neuralgia (PHN) and select the best treatment methods. Methods 80 patients with post herpetic neuralgia from 2013~2015 in our hospital were randomly divided into control group (group A),epidural nerve block group(group B),dorsal root ganglion nerve block group(group C),intercostal nerve block group (group D),20 cases in each group.Group A used simple drug treatment,group B,C,D selected the different nerve block on the basis of drug treatment.Observed the visual analogue score(VAS) of patients at one day before treatment and 1 week,4 weeks,8 weeks, 12 weeks after treatment,and recorded the drug use of gabapentin and tramadol hydrochloride sustained release tablets. Results The VAS scores of the four groups significantly decreased after treatment,and the treatment was effective.The VAS scores after treatment in group B,C,D significantly decreased compared with group A (P<0.05),the VAS scores after treatment from low to high were dorsal root ganglion nerve block group,epidural nerve block group and intercostal nerve block group in in-vasive treatment groups. Daily dosage of gabapentin and tramadol hydrochloride sustained release tablets in group B ,C and D were lower than that in group A after treatment (P<0.05). Daily dosage from less to more were dorsal root ganglion nerve block group,epidural nerve block group and intercostal nerve block group in invasive treatment groups. Conclusion CT guided dorsal root ganglion nerve block is the best way to alleviate neuropathic pain in patients with PHN among the three methods.