老年带状疱疹后遗神经痛病人多维度协同护理效果观察

[目的]观察多维度协同护理在老年带状疱疹后遗神经痛病人中的应用效果。[方法]将84例带状疱疹后遗神经痛老年病人按照住院尾号单双号分为对照组(40例)和观察组(44例),对照组接受常规护理,观察组接受多维度协同护理干预,干预后对两组病人的焦虑、抑郁、疼痛情况及护理效果进行比较。[结果]干预后观察组病人焦虑与抑郁评分、疼痛评分均低于对照组,临床护理总有效率高于对照组,经比较差异均有统计学意义(P均0.05)。[结论]对带状疱疹后遗神经痛老年病人实施多维度协同护理,有利于改善病人的负性情绪,降低疼痛程度,提高临床护理疗效。     

神经阻滞治疗带状疱疹神经痛临床疗效观察

目的 探讨神经阻滞在治疗带状疱疹神经痛及带状疱疹后神经痛(PNH)中的临床疗效.方法 总结我院麻醉科疼痛病房2003年3月至2007年10月所收治的167例带状疱疹神经痛及PNH患者,比较单纯药物治疗与合用神经阻滞治疗后疼痛缓解程度(VAS评分),自觉疼痛缓解程度评分、睡眠受影响率、并发症发生情况.结果 167例患者中,带状疱疹神经痛组(85例)中,单纯药物治疗后,VAS评分降低(1.61±1.8)分,72%患者仍存在中～重度疼痛;合用神经阻滞治疗后,VAS评分降低(4.14±2.17)分,63%患者睡眠改善.PNH组(82例)中,单纯药物治疗后,VAS评分降低(1.21±0.96)分,85%患者仍存在中～重度疼痛;合用神经阻滞治疗后,VAS评分降低(4.21±1.77)分,55%患者睡眠改善.结论 神经阻滞治疗对带状疱疹神经痛及PNH均有疗效.     

急性带状疱疹患者Treg和IL-35水平与带状疱疹后遗神经痛的相关性分析

目的 分析急性带状疱疹(AHZ)患者外周血中调节性T细胞(Treg)和白细胞介素(IL)-35水平与带状疱疹后遗神经痛(PHN)之间的关系.方法 选取2017年11月至2018年10月在福建医科大学附属闽东医院就诊的68例AHZ患者作为观察组,并选择同期20例体检健康者作为对照组.3个月后随访,根据是否出现PHN将患者...     

Occipital neuralgia evoked by facial herpes zoster infection

Occipital neuralgia is a pain syndrome which may usually be induced by spasms of the cervical muscles or trauma to the greater or lesser occipital nerves. We report a patient with occipital neuralgia followed by facial herpes lesion. A 74-year-old male experienced sudden-onset severe headache in the occipital area. The pain was localized to the distribution of the right side of the greater occipital nerve, and palpation of the right greater occipital nerve reproduces the pain. He was diagnosed with occipital neuralgia according to ICHD-II criteria. A few days later, the occipital pain was followed by reddening of the skin and the appearance, of varying size, of vesicles on the right side of his face (the maxillary nerve and the mandibular nerve region). This was diagnosed as herpes zoster. This case represents a combination of facial herpes lesions and pain in the C2 and C3 regions. The pain syndromes can be confusing, and the classic herpes zoster infection should be considered even when no skin lesions are established.     

前列腺素E1治疗带状疱疹后遗神经痛临床试验研究

目的研究前列腺素E1脂微球载体制剂(LipoPGE1,凯时)治疗顽固性带状疱疹后遗神经痛的疗效及不良反应。方法按随机对照原则将持续疼痛1个月以上的带状疱疹后遗神经痛患者分为对照组(A组)和试验组(B组),除了同时应用曲马多缓释胶囊治疗外,对照组采用静脉封闭疗法,而试验组则采用LipoPGE1治疗。结果试验组加用LipoPGE1治疗1周后,疼痛明显缓解,总有效率达95%,对照组有效率仅达60%,但两者秩和检验差异无显著性的意义(P>0.01)。治疗后2、4和8周随访,试验组的显效率和治愈率明显优于对照组,且秩和检验在统计学上差异有非常显著的意义(P<0.01)。结论LipoPGE1是治疗顽固性带状疱疹后遗神经痛的有效且安全的药物。     

多模态磁共振成像在带状疱疹后神经痛的研究进展

带状疱疹后神经痛(postherpetic neuralgia,PHN)是临床常见的神经病理性疼痛。目前,其发病的中枢机制尚未完全阐明,故临床治疗比较困难。近年来,随着MRI技术的发展,多模态MRI在探讨PHN发病的中枢机制中发挥着相互补充的作用。笔者主要对多模态MRI在PHN的研究进展进行综述,为研究PHN发病中枢机制及临床治疗提供线索。     

B超引导下胸椎旁神经阻滞治疗急性带状疱疹肋间神经痛的研究

目的:探讨B超引导下胸椎旁神经阻滞在治疗急性带状疱疹肋间神经痛中的临床疗效。方法:80例胸背部急性带状疱疹伴肋间神经痛患者随机分为两组,每组各40例。A组(对照组)予常规抗病毒及按需口服镇痛药物治疗,B组(试验组)同时接受在B超引导下选择性胸椎旁神经阻滞治疗。观察治疗后7、14及30天两组患者疼痛视觉模拟评分(VAS)、辅助镇痛药用量、不良反应及后遗神经痛(PHN)发生率。结果:治疗后各观察时间点两组VAS评分均较治疗前降低(P0.009),组间比较差异显著,B组明显低于A组(P0.05)。辅助镇痛药物用量、PHN发生率B组亦显著低于A组(P0.05)。两组均无明显不良反应发生。结论:B超引导下胸椎旁神经阻滞联合抗毒治疗急性带状疱疹肋间神经痛安全有效,明显优于单纯药物治疗,并可减少后遗神经痛的发生率,值得临床推广应用。     

持续硬膜外输注镇痛结合交感神经射频热凝治疗四肢带状疱疹后遗神经痛的疗效

摘要 目的：观察CT 引导下四肢带状疱疹后遗神经痛（PHN）持续硬膜外输注镇痛结合交感神经射频热凝治疗的临床结果。 方法：32例四肢带状疱疹后遗神经痛患者随机分为对照组（A组,采用硬膜外置管持续输注镇痛治疗,n=17）和联合治疗组（B组,采用持续硬膜外置管镇痛3—4周后行交感神经射频热凝治疗3次,n=15）,比较治疗前后7d、1个月、6个月、1年的视觉模拟评分（VAS）、疼痛缓解率、生存质量评分（QOL）、麻木评分、肌力下降发生率。 结果：治疗后两组患者的VAS评分均较治疗前明显降低（P<0.05）;治疗后6个月、1年,B组的VAS、QOL、疼痛缓解率均优于A组（P<0.05）,同时A、B两组的麻木发生率和麻木评分均无显著性差异（P>0.05）,治疗后两组均无肌力下降发生。 结论：四肢带状疱疹后遗神经痛持续硬膜外镇痛结合交感神经射频毁损治疗可有效缓解疼痛,长期疗效高于单纯持续硬膜外镇痛,同时并不增加麻木及肌力下降的发生率。     

超声引导下颈神经根脉冲射频治疗带状疱疹神经痛的临床研究

目的:探讨超声引导下颈神经根脉冲射频治疗上肢带状疱疹神经痛的临床疗效.方法:采用前瞻性随机对照研究方法,符合入组标准的上肢带状疱疹神经痛病人采用随机数字表法分为超声组(n=36)和透视组(n=37).受累颈神经根超声引导下脉冲射频42℃360 s.主要终点指标:术后1天、2周、4周、12周和24周疼痛数字评分法(num...     

躯干部带状疱疹急慢性期脑功能低频振荡幅度观察

目的:利用功能性磁共振技术比较躯干部带状疱疹患者2个时期的低频振荡幅度,通过图像化方式描述不同时期带状疱疹患者大脑神经功能活动的情况。方法:将符合条件的6名带状疱疹患者在不同阶段分别给予功能磁共振扫描,扫描后通过统计软件处理分析得到低频振幅(ALFF)数据统计结果,将对比结果通过软件图像化。然后对两者统计学差异部分进行分析。结果:对比慢性期与带状疱疹后神经痛期的ALFF结果,前者较后者数值升高的区域有:左前扣带回、双侧侧脑岛、双侧小脑、左梭状回。结论:前扣带回、脑岛、小脑、梭状回等部位在躯干部位的带状疱疹后神经痛的机制中起重要作用。     

Efficacy and safety of twice-daily tramadol hydrochloride bilayer sustained-release tablets with an immediate release component for postherpetic neuralgia: Results of a Phase III,randomized, double-blind,placebo-controlled,treatment-withdrawal study

Background

We investigated the efficacy and safety of twice-daily bilayer sustained-release tramadol hydrochloride tablets (35% immediate-release; 65% sustained-release) in patients with postherpetic neuralgia.

Methods

This was a Phase III treatment-withdrawal study with 1–4-week dose-escalation, 1-week fixed-dose, and 4-week randomized, double-blind, placebo-controlled withdrawal periods performed at 43 medical institutions in Japan. Patients aged ≥20 years, ≥3 months after the onset of herpes zoster with localized, persistent pain despite fixed-dose analgesics for ≥2 weeks before enrollment were eligible. Patients started tramadol at 100 mg/day and its dose escalated to a maximum of 400 mg/day to achieve a reduction in their Numeric Rating Scale (NRS) for pain of ≥2 points. Eligible patients were randomized to continue tramadol or switched to placebo for 4 weeks (double-blind period). Patients were withdrawn due to inadequate analgesia (NRS deteriorated on ≥2 consecutive days) or their request.

Results

Overall, 252 patients started tramadol and 173 were randomized (tramadol: 85; placebo: 88). Tramadol was superior to placebo for the primary endpoint (time from randomization to an inadequate analgesic effect) with log-rank test p = 0.0005. The hazard ratio was 0.353 (95% confidence interval 0.190–0.657) in favor of tramadol and fewer patients in the tramadol group experienced inadequate analgesic effects (16.9% vs. 39.8%). Adverse events in ≥10% of patients in the open-label period were constipation (43.8%), nausea (34.9%), somnolence (18.5%), and dizziness (11.6%). The frequencies of adverse events in the double-blind period were similar in both groups.

Conclusion

Sustained-release tramadol tablets with an immediate-release component are effective and well tolerated for managing postherpetic neuralgia.     

复方倍他米松神经阻滞治疗胸背部带状疱疹后神经痛的疗效

目的探讨复方倍他米松神经阻滞治疗胸背部带状疱疹后神经痛（PHN）的疗效。方法选择胸背部带状疱疹后神经痛40例。随机分为研究组和对照组,分别采用复方倍他米松和曲安奈德合并维生素B12行肋间神经阻滞。在第1周-第4周、第8周测定视觉模拟评分（VAS）和睡眠质量评分（QS）综合评定治疗结果。结果与治疗前比较,研究组治疗后各时段的VAS评分明显下降,差异均有统计学意义（1分别=19．80、25．58、33．96、39．82、37．86,P均〈0．05）;与对照组比较。研究组治疗后各时段的VAS评分明显下降,差异均有统计学意义（t分别=9．31j3．04、7．53、4．89、2．85,P均〈0．05）。研究组治疗后QS评分与治疗前比较,差异有统计学意义（t分别=12．06、19．88、21．94、31．72、35-36,P均〈0．05）,与对照组比较。研究组治疗后QS评分明显下降,差异有统计学意义（t分别=5．11、7．25、11．90、8．49、6．86。P均〈0．05）。研究组治疗后显效率为85％,与对照组比较。差异有统计学意义（x^2=4．02,P〈0．05）。结论复方倍他米松合并维生素B12行肋间神经阻滞治疗胸背部PHN具有起效快、发挥作用时间长等特点,从而达到更好的止痛效果,改善患者的生活质量。     

The role of sympathetic nerve blocks in herpes zoster and postherpetic neuralgia

The most common complication of herpes zoster in immunocompetent patients is postherpetic neuralgia (PHN). Sympathetic blocks have been traditionally used for patients with herpes zoster and PHN with three different therapeutic goals: pain relief during acute herpes zoster, pain relief during PHN, and prevention of PHN by treating patients with acute zoster. The role of sympathetic blocks in herpes zoster and PHN remains controversial due to methodologic shortcomings in published studies and the limited current understanding of the role of the sympathetic nervous system in mediating pain. Current theories of the pathophysiology of PHN, the role of the sympathetic nervous system in herpes zoster and PHN, and published studies investigating use of sympathetic nerve blocks in herpes zoster and PHN are reviewed.     

腺苷钴胺联合经皮神经电刺激治疗老年带状疱疹后神经痛的临床观察

目的:探讨腺苷钴胺联合经皮神经电刺激(TENS)治疗带状疱疹后神经痛的临床疗效。方法:选取2007年10月—2009年4月于卫生部北京医院疼痛诊疗中心就诊的带状疱疹后神经痛(PHN)患者60例,随机分为3组。A组应用TENS,B组应用腺苷钴胺,C组联合应用腺苷钴胺及TENS,疗程10d。应用视觉模拟量表(VAS)及5级评分法对疗效进行评价。结果:治疗后,联合治疗组(C组)VAS评分及5级评分均低于独立治疗组(A和B组);联合治疗组的两种评分差值均高于独立治疗组;联合治疗组有效率(100%)高于独立治疗组(65%和60%),差异均有显著性意义(P0.05)。结论:腺苷钴胺联合TENS治疗带状疱疹后神经痛有效,可减轻疼痛程度并改善睡眠。     

Zostavax: a subcutaneous vaccine for the prevention of herpes zoster

Introduction: Herpes zoster (HZ) occurs as a reactivation of dormant varicella zoster virus (VZV), and occurs more frequently in the aging population or the immunocompromised due to waning cell-mediated immunity. Up to 1 million cases of HZ are reported annually in the USA with an estimated 10 – 30% of the population being affected by shingles in their lifetime. HZ is a debilitating illness, and while mortality is low, morbidity remains a significant cause for concern with prevention efforts aimed at reducing VZV reactivation and its complications. The HZ vaccine was approved by the US Food and Drug Administration for individuals aged 50-years or older. However, the Center for Disease Control and Prevention's Advisory Committee for Immunization Practices recommends the vaccine in individuals aged 60-years or older.

Areas covered: Recent literature investigating the efficacy and indications of live attenuated zoster vaccine.

Expert opinion: Live attenuated zoster vaccine is safe and efficacious in preventing HZ and decreasing the morbidity associated with postherpetic neuralgia. The vaccine is FDA approved in individuals aged 50-years or older but further studies are warranted to investigate the vaccine's efficacy in immunosuppressed and immunocompromised patients.     

普瑞巴林联合神经阻滞治疗老年带状疱疹后三叉神经痛的疗效

目的观察普瑞巴林联合神经阻滞治疗老年带状疱疹后三叉神经痛的效果。方法 45例带状疱疹后三叉神经痛患者随机分为观察组和对照组,对照组采用口服普瑞巴林胶囊,观察组在对照组的基础上加用神经阻滞法。治疗4周后采用视觉模拟评分(VAS)和睡眠质量评分(PSQI)评价临床疗效。结果 2组患者治疗前及治疗1周后VAS评分和PSQI评分均无显著差异(P0.05),但治疗第2、3、4周,2组患者VAS评分和PSQI评分均显著降低,且观察组较对照组降低更为显著,差异有统计学意义(P0.05)。结论普瑞巴林联合神经阻滞治疗老年带状疱疹后三叉神经痛效果好,操作简单,值得临床应用。     

复合维生素治疗带状疱疹顽固性疼痛134例疗效分析

目的分析复合维生素治疗带状疱疹顽固性疼痛134例疗效。方法采用神经阻滞，疱疹区域相应神经节段椎旁阻滞相应星状神经节治疗。结果痊愈68例，好转23例，无效43例。结论带状疱疹虽然是自愈性疾病，但早期接受区域神经阻滞治疗，对缓解疼痛，缩短病程，疗效显著，值得临床推广应用。     

Acute herpes zoster and postherpetic neuralgia

Herpes zoster is a common illness in aged patients that is characterized by shingles and severe segmental pain. The nature and duration of the illness is highly variable, and it is also very difficult to relieve. This review of pain in acute herpes zoster and postherpetic neuralgia analyzes clinical observations and describes new treatments that have the potential to improve the lives of patients who suffer from these two illnesses.     

Herpes Zoster Immunization in Older Adults Has Big Benefits

The value and importance of providing herpes zoster immunization to reduce the incidence and severity of acute herpes zoster neuralgia, especially in older patients, is described. The prevention of postherpetic neuralgia can profoundly impact patients’ quality of life.

This report is adapted from paineurope 2014; Issue 4, © Haymarket Medical Publications Ltd, and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free of charge to healthcare professionals in Europe. Archival issues can be viewed via the website: www.paineurope.com at which health professionals can find links to the original articles and request copies of the quarterly publication and access additional pain education and pain management resources.