饮食护理干预对带状疱疹后遗神经痛治疗效果的作用

目的：观察饮食护理干预对带状疱疹后遗神经痛治疗效果的作用.方法：将100例带状疱疹后遗神经痛患者随机分成观察组50例和对照组50例,对照组给予带状疱疹后遗神经痛患者常规护理;观察组在对照组基础上实施饮食护理干预.结果：观察组饮食干预后疼痛、疗效与对照组比较差异有统计学意义（P〈0.05）.结论：饮食干预能减少带状疱疹后遗神经痛患者反复加重,减轻患者疼痛程度,有利于康复.     

疏血通注射液联合甲钴铵治疗带状疱疹神经痛20例

目的 观察疏血通注射液联合甲钴铵对带状疱疹后神经痛的治疗作用.方法 将40例确诊为带状疱疹后神经痛的患者随机分为疏血通联合甲钴铵组(治疗组)和甲钴铵组(对照组),比较治疗前后疼痛视觉模拟评分和睡眠质量的改变.结果 治疗2周后,两组患者的带状疱疹后神经痛均有改善,治疗组和对照组治疗有效率分别为95%(19/20)和60%(12/20),睡眠质量改善率分别是85%(17/20)和55%(11/20),两组比较差异有统计学意义(P<0.05).治疗后治疗组疼痛的改善较对照组明显(P<0.05).结论 疏血通注射液联合甲钴铵对带状疱疹后神经痛有较好的疗效.     

带状疱疹后神经痛的治疗

带状疱疹后神经痛(PHN)是指带状疱疹皮损消退后,受累区皮肤疼痛持续3个月以上,因其发生率高(9%～13%带状疱疹患者可出现带状疱疹后神经痛、60岁以上老龄患者带状疱疹后神经痛发病率可高达50%～75%[1])、持续时间长(可达3.5年).迄今仍有50%的带状疱疹后神经痛患者未得到合理、有效的治疗[2],所以其治疗尤为重要,现综述如下.     

探讨普瑞巴林对糖尿病合并带状疱疹后神经痛的临床治疗效果

目的研究分析普瑞巴林对糖尿病合并带状疱疹后神经痛的临床治疗效果。方法选择2017年2月-2019年5月期间该院收治的50例糖尿病合并带状疱疹后神经痛患者为该次研究对象,将所有患者随机分为对照组和研究组,各25例,对照组患者采用盐酸羟考酮缓释片治疗,研究组患者在对照组的基础上采用普瑞巴林治疗,观察两组患者治疗前后疼痛程度、血糖水平和不良反应,并对数据进行分析统计。结果两组患者治疗前VAS评分差异无统计学意义(P>0.05),治疗后研究组患者VAS评分显著低于对照组(P<0.05),两组患者空腹血糖、餐后2 h血糖对比差异无统计学意义(P>0.05),同时研究组患者不良反应发生率均明显低于对照组(P<0.05)。结论在糖尿病合并带状疱疹后神经痛患者的临床治疗中,普瑞巴林疗效显著,可有效缓解患者疼痛,对血糖影响小,不良反应发生率低,具有较高的用药安全性,值得临床应用推广。     

微波联合七叶皂苷钠治疗中老年带状疱疹的临床疗效观察

［摘要］　目的　观察微波联合七叶皂苷钠对中老年带状疱疹的治疗效果。方法　选择2018年9月至2022年3月中国人民解放军63750部队医院收治的带状疱疹患者120例,采用随机数字表法将其分为观察组和对照组,每组60例。对照组接受抗病毒、营养神经治疗。观察组在对照组治疗方案基础上给予微波联合七叶皂苷钠治疗。于治疗前和治疗后第1、2周对两组进行皮肤病生活质量指数（DLQI）、数字评定量表(NRS)和语言描述分级量表（VRS）评分,比较两组疼痛缓解时间、结痂时间、皮损消退时间以及后遗神经痛(PHN)发生率。结果　经治疗后,两组DLQI、NRS、VRS评分均较治疗前下降,且观察组评分下降幅度更大（P<0.05）。在治疗后第1、2周,观察组DLQI、NRS、VRS评分均低于对照组,差异有统计学意义（P<0.05）。观察组疼痛缓解时间、疱疹结痂时间、皮损消退时间均短于对照组,差异有统计学意义（P<0.05）。在皮损消退后4周,对照组有6例(10.00%)发生PHN,观察组有2例（3.33%）发生PHN,两组PHN发生率比较差异无统计学意义（χ²=1.205,P=0.272）。两组不良反应发生率比较差异无统计学意义（5.00% vs 3.33%; χ²=0.000,P=1.000）。结论　微波联合七叶皂苷钠治疗可有效减轻带状疱疼痛症状,促进疱疹结痂及皮损愈合,提高患者的生活质量。     

富血小板血浆联合加巴喷丁治疗带状疱疹性神经痛的效果观察

目的观察富血小板血浆联合加巴喷丁治疗带状疱疹性神经痛的临床疗效。方法选择2019-10~2020-04于广西医科大学第二附属医院疼痛科就诊的带状疱疹性神经痛患者36例,采用随机数字表法将其分为观察组和对照组,每组18例。对照组予常规抗病毒及口服加巴喷丁治疗,观察组在此基础上加用超声引导下富血小板血浆注射靶神经治疗。比较两组临床疗效及疼痛程度,并记录两组治疗过程中出现的不良反应。结果治疗后,两组数字评分量表(NRS)评分均呈下降趋势,与同组治疗前比较差异均有统计学意义(P<0.05)。治疗后观察组各时点的NRS评分均显著低于对照组(P<0.05)。观察组临床治愈13例,临床好转4例,无效1例;对照组临床治愈6例,临床好转6例,无效6例。观察组临床疗效优于对照组(Z=2.491,P=0.013)。两组治疗过程中均未见严重不良反应。结论与传统单纯药物治疗比较,超声引导下富血小板血浆注射治疗带状疱疹性神经痛具有镇痛效果好、副作用少的优点,为带状疱疹性神经痛的治疗提供了新思路。     

口服糖皮质激素对带状疱疹后遗神经痛患者的临床疗效观察

目的观察口服糖皮质激素对带状疱疹后遗神经痛的临床疗效。方法将2018-12～2019-10该院90例带状疱疹后遗神经痛患者随机分为观察组和对照组各45例,两组患者均给予维生素B1及腺苷钴胺肌肉注射,同时给予红光照射治疗,观察组加用醋酸泼尼松片口服治疗2周。采用视觉模拟量表(Visual Analogue Scale,VAS)评分法评价疼痛程度及临床疗效。结果治疗前两组VAS评分比较差异无统计学意义(P0.05)。观察组治疗后1周和2周VAS评分均低于对照组(P均0.05)。观察组总有效率明显高于对照组(95.6%vs 80.0%,P 0.05)。两组未见严重不良反应。结论口服糖皮质激素对带状疱疹后遗神经痛患者疗效明确,可以有效减少疼痛程度,短期使用不良反应较少。     

针刺治疗老年2型糖尿病合并带状疱疹的临床观察

目的：观察针刺治疗老年2型糖尿病合并带状疱疹的临床疗效。方法选取80例2型糖尿病合并带状疱疹的老年患者,随机均分为治疗组和对照组。治疗组40例采用体针调理同时配合局部围刺的治疗方法,对照组40例采用西药治疗。比较分析两组的疗效和临床症状等相关指标。结果治疗组痊愈31例,好转4例,无效2例,后遗神经痛3例,总有效率为87.5%;对照组痊愈20例,好转6例,无效10例,后遗神经痛4例,总有效率为65.0%。两组疗效差异具有统计学意义（P＜0.05）。治疗组的结痂时间和皮损消退时间明显短于对照组,差异具有统计学意义（P＜0.05）。治疗结束后治疗组患者的空腹及三餐后血糖均明显低于对照组患者,差异具有统计学意义（P＜0.05）。结论针刺治疗老年2型糖尿病合并带状疱疹的效果较好。     

梅花针叩刺放血结合激光照射治疗早期带状疱疹的临床疗效观察

目的观察梅花针叩刺局部放血结合激光照射皮损部位治疗早期带状疱疹的临床疗效及预后情况。方法选取2016年12月—2018年10月于我院治疗的68例早期带状疱疹患者作为研究对象,按照随机数字表法分为观察组与对照组,各34例,其中对照组采用西医常规治疗及护理,观察组在对照组治疗基础上另给予梅花针叩刺放血结合激光照射治疗。结果治疗结束后,观察组总有效率为94.12%,明显高于对照组的79.41%(P<0.05)。治疗结束后1个月、2个月进行随访时,观察组总有效率也均明显高于对照组(P均<0.05)。2组患者疼痛视觉模拟评分均较治疗前明显下降(P均<0.05),且观察组下降差值大于对照组(P<0.05)。结论梅花针叩刺放血结合激光照射治疗早期带状疱疹可缩短病程,减轻患者疼痛,具有较好的临床疗效。     

中等剂量糖皮质类固醇激素缓解带状疱疹疼痛及肿胀的疗效

目的探讨中等剂量糖皮质类固醇激素对缓解带状疱疹疼痛及肿胀的疗效。方法 62例带状疱疹患者按治疗方法分为观察组32例和对照组30例。两组均常规内服抗病毒、营养神经药物,观察组在此基础上给予泼尼松片,10 mg/次,3次/d,以7 d为1个疗程。比较两组止疱时间、结痂时间、疼痛消失时间、水肿消退及皮损痊愈时间及疼痛评分,并评价疗效。结果观察组总有效率为96.87%(31/32),与对照组86.67%(26/30)比较差异无统计学意义(χ2=2.12,P>0.05);观察组痊愈率〔46.88%(15/32)〕明显高于对照组〔26.67%(8/30)〕(χ2=4.67,P<0.05)。观察组止疱时间、结痂时间、疼痛消失时间、水肿消退及皮损痊愈时间均早于对照组(t=4.23、4.01、4.51、6.43、5.21,均P<0.05)。观察组治疗后疼痛评分较治疗前显著下降(t=7.13,P<0.05),且显著低于对照组(t=5.21,P<0.05)。结论中等剂量糖皮质类固醇激素能有效缓解带状疱疹疼痛及局部水肿,促进皮损愈合。     

贺氏针灸三通法治疗带状疱疹的临床疗效观察

目的观察贺氏针灸三通法治疗带状疱疹的疗效。方法将103例患者随机分为三通法组(53例)和西药组(50例),分别采用贺氏针灸三通法和西药治疗。结果三通法组总有效率为100.0%,痊愈率为81.1%。西药组总有效率为82.0%,痊愈率为56.0%。贺氏针灸三通法组疗效优于西药组,差异有统计学意义(P0.05)。结论贺氏针灸三通法治疗带状疱疹具有疗效显著、止痛结痂快、疗程短、后遗神经痛发生率低等优点。     

A prognostic score for postherpetic neuralgia in ambulatory patients

Summary The main objective was to develop a scoring system for easy use by the physician in daily clinical practice in deciding the appropriate treatment for his herpes zoster patient. Data from 635 patients who did not receive antiviral therapy were included in this analysis. Of these, 131 developed postherpetic neuralgia (PHN). Of the 29 variables tested univariately in this study, 15 showed a significant correlation with the incidence of PHN, but only six proved to contribute to the overall predictive power in the multivariate approach. Using two independent approaches, the model showed a very satisfactory performance in the validation sample. Patients without acute pain rarely developed PHN. In those with acute pain, being female, being over 50 years of age, having more than 50 lesions, having lesions of a hemorrhagic nature, having cranial or sacral localisation of the rash or having pain in the prodromal phase proved to be significant, multivariate factors. An easy-to-use scoring system used in a risk graph is proposed. These data should be useful in the individual treatment decision as well as in the design and analysis of therapeutic trials in herpes zoster.     

Cerebrospinal fluid interleukin 8 concentrations and the subsequent development of postherpetic neuralgia

PURPOSE: Other than age, the risk factors for postherpetic neuralgia are not well established. We studied whether the concentration of interleukin 8 in the cerebrospinal fluid is associated with the risk of postherpetic neuralgia. METHODS: We enrolled 170 patients more than 50 years old who had a typical painful and nontrigeminal herpetic rash. Patients were treated with acyclovir; no corticosteroids were given. Cerebrospinal fluid was taken for analysis of interleukin 8 during and at full crusting of the herpetic rash. Age, sex, comorbid conditions, prodromal pain, localization and severity of herpetic rash, number of skin lesions, and degree of pain were recorded. We used multivariate logistic regression modeling to identify significant predictive factors. Receiver operating characteristic (ROC) curves were evaluated to determine the contribution of each factor. RESULTS: Six months after healing, 31 patients (18%) had postherpetic neuralgia; 27 patients still had it after 1 year. Only three variables-age (odds ratio [OR] = 2.7 per 10-year increase; 95% confidence interval [CI]: 1.2 to 6.2), acute pain (OR = 1.8 per unit increase in visual analog scale; 95% CI: 1.2 to 2.8), and interleukin 8 concentration in the cerebrospinal fluid at full crusting of the herpetic rash (OR = 1.6 per 20-microg/L increase; 95% CI: 1.3 to 2.0)-were significant predictors of postherpetic neuralgia at 1 year. Interleukin 8 concentration also had the highest area under the ROC curve at these evaluation points (P <0.001). CONCLUSION: Our results suggest that interleukin 8 concentration in the cerebrospinal fluid at full crusting of herpetic rash may be useful for identifying patients who are likely to develop intractable postherpetic neuralgia.     

Tratamiento del herpes zoster en pacientes inmunocompetentes e inmunodeprimidos

Herpes zoster (HZ) is a clinical manifestation of the reactivation of latent varicella zoster virus infection. Patients may have acute neuritic pain, together with cutaneous vesicular lesions in a dermatomal distribution. Recently, new antiviral drugs have been highly useful in the treatment of patients with HZ, avoiding many of the secondary complications that can appear after this herpetic infection. In addition, the rational and early use of these antiviral drugs may reduce the virulence of postherpetic neuralgia in a substantial proportion of patients. Consequently, guidelines for the management and treatment of patients with HZ should be established. Specifically, guidelines should be established for certain patient groups at risk for an atypical or severe clinical course, such as immunosuppressed patients (those with solid organ transplants, HIV infection or AIDS, or patients under immunosuppressive treatment) or pregnant and pediatric patients. In addition, antiviral treatment must be administered with analgesic drugs to control neuritic pain in all patients with HZ, whether in the acute phase or in the form of postherpetic neuralgia.     

Isoprinosine does not influence the natural history of herpes zoster or postherpetic neuralgia

In a double-blind randomised trial, 38 elderly patients with acute herpes zoster received either isoprinosine (IP) or placebo. IP neither shortened the acute phase of herpes zoster nor prevented postherpetic neuralgia. Transient asymptomatic hyperuricaemia affected one third of IP treated patients. Shortcomings in study design and misleading interpretation of results are common in previously published clinical trials of herpes zoster and postherpetic neuralgia. Guidelines for future studies are proposed.     

Persistence of varicella zoster virus DNA in saliva after herpes zoster

Analysis of saliva samples from individuals aged ≥ 60 years who had a history of zoster (group 1), zoster and postherpetic neuralgia (PHN; group 2), or no history of zoster (group 3) revealed varicella zoster virus (VZV) DNA in saliva samples from 11 of 17 individuals in group 1, 10 of 15 individuals in group 2, and 2 of 17 individuals in group 3. The frequency of VZV DNA detection was significantly higher (P = .001) in saliva of subjects with a history of zoster, with or without PHN (21 [67%] of 32 subjects in groups 1 and 2), than in saliva of age-matched subjects with no zoster history (2 [12%] of 17 subjects in group 3). Thus, persistence of VZV DNA in saliva is the outcome of zoster, independent of PHN. Because VZV infection can produce neurological and ocular disease without zoster rash, future studies are needed to establish whether VZV DNA can be detected in the saliva of such patients.     

A case of rheumatoid arthritis presenting with postherpetic neuralgia and abdominal-wall pseudohernia

Postherpetic neuralgia is a common complication, while the postherpetic abdominal-wall pseudohernia (AWP) is a quite rare complication of herpes zoster (HZ). We report a patient >45?years of age with a history of rheumatoid arthritis (RA) who presented with two chronic HZ complications. A 75-year-old woman was admitted with neuralgia following cutaneous herpes zoster 6?weeks before. She was on long-term glucocorticoid, antimalarial and non-steroidal anti-inflammatory treatment. Confluent ulcers began to fill with granulation tissue, crusts, scars and skin discoloration in the area of the left T12-L2 dermatomes and reducible, painless swelling of the left flank, 20?×?20?cm, without palpable defect in abdominal-wall. There were typical joint deformity and positive rheumatoid factor. On neurological examination superficial abdominal reflexes were diminished in the left side, with hypesthesia of the overlying skin. Needle electromyography revealed denervational changes limited to the left-side muscles (on affected dermatomes T12-L2). Thoracoabdominal CT did not reveal the presence of existing hernia. There was an abdominal distension, the left abdominal-wall was thinner than the right side. The patient was treated with an oral preparation containing benfotiamine and vitamins B6 and B12, carbamazepine, amitriptyline, gabapentin, and local lidocaine. Skin rash left with scarring and pigmentary changes and the abdominal-wall swelling resolved within 8?months, however, the pain still persisted. To our best knowledge, this is the first observation of RA-associated postherpetic AWP. This rare motor complication appears to be self-limited with a good prognosis for recovery, while postherpetic neuralgia may require a combination of treatments for adequate pain relief. Older age, female sex, greater rash and acute pain severity are considered as risk factors associated with severe postherpetic neuralgia. In addition, patients with RA, mainly those treated with oral corticosteroids, are also at increased risk of HZ complications.     

Viral infections.

Viral infections may cause serious morbidity as well as death in elderly patients. Of the RNA viruses, influenza virus is the most important pathogen; the majority of influenza-related deaths occur in older patients. Respiratory syncytial virus appears to be gaining increasing importance in elderly persons. Herpes zoster or shingles is caused by the DNA virus, varicella-zoster virus, and its major morbidity in older patients is postherpetic neuralgia.     

Herpes zoster in the elderly: issues related to geriatrics.

This article reviews specific clinical and research issues of herpes zoster related to geriatric medicine. Salient epidemiological and clinical issues include the increasing probability of zoster and postherpetic neuralgia with aging, age-related decline in immunity to varicella-zoster virus, the functional and psychosocial impact of zoster on the quality of life of the elderly, illness behavior in elderly patients with zoster, and varicella-zoster virus transmission and control in the nursing home. The role of antiviral therapy, corticosteroids, and analgesics; the measurement and analysis of pain, health-related quality of life, and functional status; and development of the varicella vaccine in the management of zoster in the elderly are also emphasized. Fertile research opportunities exist within these areas for investigators interested in infectious diseases, geriatrics, and other zoster-related disciplines.     

Is VZV reactivation a common cause of unexplained unilateral pain? Results of a prospective study of 57 patients

OBJECTIVE: Pain is a common reason for patients to present to a doctor. Many patients with zoster have seen their doctor with pain during the days before the rash and zoster sine herpete is well described. If early varicella zoster virus (VZV) reactivation could be identified confidently, it could provide an opportunity for early antiviral intervention. This prospective study was performed to assess how often patients presenting to their general practitioner with unilateral pain of no obvious clinical cause proved to have evidence of VZV reactivation. METHODS: Fifty-seven patients were recruited and followed for 28 days; laboratory testing included VZV polymerase chain reaction (PCR) from peripheral blood mononuclear cells, VZV IgG, IgA and IgM. The control group consisted of 81 blood donors. RESULTS: Only two study patients developed the rash of zoster. There was no significant difference in PCR or serological responses between the study group and control group. Clinical characteristics did not enable identification of patients presenting to their doctor with unilateral pain who had prodromal zoster. CONCLUSION: There was no evidence on clinical or laboratory tests used in this study to support the view that reactivation of VZV is a common cause of unexplained unilateral pain.