神经阻滞治疗带状疱疹神经痛临床疗效观察

目的：对采取神经阻滞疗法治疗带状疱疹神经痛的临床效果进行深入分析和研究。方法：选取我院2015年4月~2016年4月收治的85例带状疱疹神经痛患者纳入本次研究中,依照治疗方式不同分成探究组和对比组,分别是44例和41例;对比组单一用药对症治疗,探究组同时进行神经阻滞治疗,治疗后对两组治疗前后VAS评分、临床总有效率及用药不良反应进行比较分析。结果：治疗后,两组患者的VAS评分均有所改善,探究组要优于对比组,差异有统计意义（P＜0.05）;探究组临床总有效率为82.5%,对比组为58.6%,数据对比有显著性差异（P＜0.05）。结论：对于带状疱疹神经痛,在常规对症用药治疗同时,进行神经阻滞治疗效果更为优,可有效缓解疼痛症状,促进患者康复,且安全性高,临床意义重大。     

神经阻滞联合加巴喷丁治疗带状疱疹后神经痛

目的采用加巴喷丁联合神经阻滞治疗PHN,观察其疗效。方法将46例PHN患者随机分为2组,每组23例,分别接受神经阻滞（A组）和神经阻滞联合口服加巴喷丁治疗（B组）,用视觉模拟评分（VAS）、口述评分（VRS）、六点行为活动评分（BRS—S）及睡眠时间评定近期疗效,观察并发症及药物副作用。结果在4周观察期间．两组患者治疗后各时点与治疗前相比疼痛评分随时间下降,睡眠时问增加（P〈0．05）。B组的疼痛评分下降大于A组,24h睡眠时间增加大于A组（P〈0．05）．两组未出现并发症及严重的药物的副作用。结论神经阻滞联合加巴喷丁治疗较单独使用神经阻滞的治疗效果更好。     

药物配合神经阻滞治疗带状疱疹神经痛的效果观察

目的：探讨药物配合神经阻滞治疗PHN的疗效.方法：选择我院60例PHN住院患者进行药物配合神经阻滞治疗,评估患者入院、出院时的疼痛程度及治疗效果。结果：60例PHN患者临床治愈34例(57.5%),好转21例(35%),无效4例(7.5%),总有效率92.5%。无1例患者出现神经根损伤及全脊麻危象,安全性高。结论：本研究应用无创疗法和微创疗法对PHN进行综合治疗,疗效可靠,安全性高、副作用少,可明显改善患者生活质量。     

带状疱疹后遗神经痛是怎么回事

带状疱疹俗称“缠腰龙”,近年来的发病率明显增高,而且多易发生于老年人。带状疱疹是疱疹病毒侵犯神经,引起该神经支配区疼痛及以皮肤疱疹为特征的一种疼痛性疾病。疼痛多发生在胸部、腰部、面部,也可累及上肢、会阴及腿部。很多患者在疱疹消失后,仍被病变部位的疼痛所困扰,有的甚至超过数十年。疼痛学上把疱疹消失后疼痛持续存在半年以上称为带状疱疹后遗神经痛。以往本病多在皮肤科就诊,现在由于对本病病因认识的进展及疗效较好的注射疗法和物理疗法等的应用,疼痛科在带状疱疹后遗神经痛方面的治疗优势突显出来。希望被疼痛所困扰的患者不要放弃治疗的机会,尽早摆脱这种顽固性疼痛所带来的痛苦。     

神经阻滞对带状疱疹后遗神经痛的预防作用探析

目的探讨神经阻滞对带状疱疹后遗神经痛的临床应用及效果,总结分析方法。方法对该院2010年1月—2012年1月来确诊的35例带状疱疹后遗神经痛患者的临床资料进行整理分析,以神经阻滞治疗后疼痛缓解程度(VAS评分)为指标来观察神经阻滞后带状疱疹后遗神经痛临床治疗效果。结果 35例患者中,常规抗病毒药物治疗后,疼痛缓解程度(VAS评分)评分降低(2.61±1.9)分,68.6%患者仍存在中重度疼痛;之后合用神经阻滞治疗后,VAS评分降低(1.72±0.83)分,11.4%存在疼痛。合用神经阻滞治疗患者临床效果更明显(P<0.05)。结论在临床预防并发症的治疗中,神经阻滞对于带状疱疹后遗神经痛的效果良好,疼痛小,安全可靠,值得在临床上借鉴使用。     

加巴喷丁治疗难治性带状疱疹后神经痛60例临床研究

目的观察与探讨加巴喷丁治疗难活性带状疱疹后神经痛（PHN）的疗效及副作用。方法对应用强阿片类药物仍无法有效控制疼痛PHN患者60例,VAS评分≥7分,应用加巴喷丁治疗前,患者所用阿片类镇痛药均不停药,而停用除阿片类镇痛药以外的其他药物。实行第1天开始1：7服加巴喷丁100mg／次、3次／d,第2天200mg／次、3次／d,第3天开始维持300mg／次、3次／d,如疼痛缓解不明显可每间隔2～4d增加剂量300mg／d,直至疼痛缓解或出现难以耐受的副作用,最高用量为1800mg／d。以疼痛明显缓解或疼痛缓解的剂量维持用药并逐渐减少镇痛药用量。治疗前以及治疗后2周以VAS评定疼痛程度,观察用药前后的VAS评分变化、药物的用量及副作用。结果治疗期间的副作用主要有乏力4例、头晕2例、嗜睡12例、恶心2例,2例因出现眼球震颤、四肢肌肉抽搐而停药,停药时剂量为900mg／d。其余58例患者中,17．2％患者治疗后基本不痛,不需再用阿片类镇痛药;24．1％稍有疼痛,镇痛药用量减少75％以上;34．5％仍有疼痛,镇病药用量减少50％～75％;24．1％疼痛改善不明显,镇痛药用量减少50％以下。治疗后VAS评分为5．31&#177;1．44,显著低于治疗前（p〈0．01）。所有患者用药前后血、尿常规、肝酶和血尿素氮、肌酐的改变基本一致,未见显著性差异。结论加巴喷丁用于治疗带状疱疹后神经痛效果确切,应用强阿片类药物的PHN患者对加巴喷定有良好的耐受性,但不良反应存在个体差异。对于难治性PHN,单独应用加巴喷丁仍无法良好控制疼痛,阿片类药物与加巴喷丁合用可更有效缓解疼痛,并明显减少阿片类药物的用量。     

聚肌胞肋间神经阻滞治疗带状疱疹神经痛

目的探讨聚肌胞镇痛复合液肋间神经阻滞治疗胸睡背部带状疱疹神经痛的疗效。方法应用聚肌胞镇痛复合液对21例带状疱疹神经痛患者进行肋间神经阻滞,2次／周,1个月后观察疗效。结果21例带状疱疹神经痛患者中痊愈18例、好转3例,治愈率95．2％,有效率达100％。结论聚肌胞镇痛复合液肋间神经阻滞治疗胸腰背部带状疱疹神经痛效果良好,操作方法简单,易于推广,有较好的实用价值。     

外周神经电刺激对带状疱疹后遗神经痛的疗效观察

目的 探讨外周神经电刺激对带状疱疹后遗神经痛的疗效.方法 将98例带状疱疹后遗神经痛患者按随机数字表法分为常规神经阻滞组(48例)和外周神经电刺激组(50例).在接受口服药物治疗的基础上,分别接受常规神经阻滞和外周神经刺激器介导的病损神经电刺激治疗.分别观察两组的疗效和6个月的复发情况.结果 治疗后第4、8、12周外周神经电刺激组疼痛视觉模拟量表(VAS)评分均明显低于常规神经阻滞组(P<0.01);随访6个月,外周神经电刺激组复发率[7.5%(3/40)]明显低于常规神经阻滞组[33.3%(13/39)](P<0.05).结论 在带状疱疹后遗神经痛的治疗方法中,外周神经电刺激是一种安全有效的治疗方法 .     

醋酸泼尼松治疗急性期带状疱疹神经痛的疗效

目的 探讨醋酸泼尼松治疗急性期带状疱疹神经痛患者的临床疗效及对患者疼痛程度、焦虑情绪、睡眠质量的影响.方法 选取2020年1月—2021年5月天津市蓟州区人民医院就诊的急性期带状疱疹神经痛患者87例为研究对象.采用随机数字表法将其分为对照组43例和观察组44例.对照组给予阿昔洛韦注射液及阿昔洛韦软膏进行治疗,此基础上,...     

加巴喷丁不同用法治疗老年带状疱疹急性期神经痛效果比较

目的探讨加巴喷丁不同用法治疗老年带状疱疹急性期神经痛的临床效果。方法选取2012年1月—2014年1月收治的带状疱疹急性期神经痛患者120例,随机分为A组和B组各60例,两组均口服加巴喷丁,A组第1天晚上服用0.3 mg,第2天早、中晚均0.3 mg,第3天早、中、晚各0.3 mg,此后维持此剂量。B组第1天早、中、晚各0.1 mg,第2天早、中、晚各0.2 mg,第3天早、中、晚各0.3 mg,此后维持此剂量。比较两组疗效及不良反应的发生率。计数资料采用χ2,P0.05为差异有统计学意义。结果 B组总有效率90.00%,A组85.00%,两组比较差异无统计学意义(P0.05);B组不良反应发生率15.00%,明显低于A组的58.33%,两组比较差异有统计学意义(P0.05)。结论对采用加巴喷丁治疗老年带状疱疹急性期神经痛的剂量第1天早、中、晚各100 mg,第2天早、中、晚各200 mg,第3天早、中、晚各300 mg,此后维持此剂量的加量方法的治疗效果更好,患者不良反应较小,值得临床推广。     

鼠神经生长因子联合椎旁阻滞技术治疗肺癌并发带状疱疹神经痛的临床研究

目的：分析鼠神经生长因子联合椎旁神经根组织在肺癌合并带状疱疹神经痛中的应用价值,为临床诊疗提供参考。方法：将62例肺癌合并带状疱疹神经痛的患者随机分为观察组和对照组,每组31例。观察组给予鼠神经生长因子联合椎旁神经根阻滞治疗;对照组给予加巴喷丁联合椎旁神经根阻滞治疗。观察两组患者治疗前及治疗后1周、2周、3周、4周的视觉模拟评分（VAS）及治疗效果。结果：治疗前,两组患者VAS无显著差异,治疗后1-4周,观察组患者VAS均低于对照组,差异有统计学意义（t=5.885,t=8.566,t=6.659,t=8.751;P〈0.05）;观察组有效31例（占96.8%）,对照组有效25例（占80.6%）,观察组总有效率高于对照组,差异有统计学意义（x^2=4.47,P〈0.05）。结论：鼠神经生长因子联合椎旁神经根治疗肺癌合并带状疱疹神经痛的有效率为96.8%,且不增加不良反应的发生,是安全、有效的治疗方法,值得临床借鉴。     

Employment related productivity loss associated with herpes zoster and postherpetic neuralgia: a 6-month prospective study

We conducted a prospective multi-center study to assess productivity loss associated with herpes zoster (HZ) and postherpetic neuralgia (PHN). From 10/2005 to 07/2006, we recruited immunocompetent subjects aged ≥50 years with HZ within 14 days of rash onset across Canada. Of the 249 patients recruited, 88 were employed. Data on employment status, absences from work, reasons for absence and effectiveness at work were documented at recruitment, 7-14-21-30-60-90-120-150 and 180 days later. The majority (64%) of employed subjects missed work because of HZ and 76% reported decreased effectiveness at work (i.e. presenteeism) because of HZ/PHN. Mean hours of absenteeism and presenteeism per working individual were 27 and 34 h, respectively. Pain severity and duration were associated with greater productivity loss. These results provide new information about the burden of HZ and PHN, which is useful for public health planning and cost-effectiveness analyses of HZ vaccination among individuals of working age.     

Effectiveness of antiviral treatment on acute phase of herpes zoster and development of post herpetic neuralgia: review of international publications

Herpes zoster is due to the reactivation of the virus causing varicella, called varicella-zoster virus. It affects peripheral nerves and causes painful skin and nerve lesions. This pain may last for months, or years after the initial lesions have resolved: post-herpetic neuralgia is the most frequent complication. Antiviral drugs, acting directly on the infectious agent are prescribed to reduce or block viral replication, relieve pain, and shorten symptom duration, especially for people of 50 years of age or more. However, there is currently no systematic collection of data concerning the effectiveness of antiviral drugs administered outside of clinical trials. This review evaluates the effectiveness of antiviral drugs on: (a) the intensity of pain and progression of the rash during the acute phase of herpes zoster, and (b) the frequency, intensity, and duration of post-herpetic neuralgia. During the acute phase, antiviral drugs (acyclovir, valacyclovir and famcyclovir) significantly reduce the intensity of acute pain, accelerate the healing of the vesicular rash, and reduce the duration of viral excretion. According to some authors, these drugs taken at an early stage of the disease would help to prevent the development of post herpetic neuralgia. But for others, there is no convincing evidence that antiviral drugs reduce the risk of painful complications.     

鼠神经生长因子治疗带状疱疹的临床研究

目的 观察鼠神经生长因子(mNGF)治疗带状疱疹的临床疗效.方法 将64例带状疱疹患者,按随机数字表法分为治疗组和对照组,每组32例,两组均给予常规治疗,治疗组在常规治疗的基础上应用mNGF肌肉注射,每日30 μg,共14d,每5d观察疼痛变化情况,共观察1个月.结果 治疗组疼痛减轻时间、疼痛消失时间分别为(4.36±2.01)、(12.29±1.98)d,均短于对照组的(7.23±3.57)、(20.36±2.24)d,差异有统计学意义(t=5.21、8.37,P＜0.01);治疗组总有效率为96.9％(31/32),显著高于对照组的71.9％(23/32),差异有统计学意义(P＜0.05).结论 mNGF配合常规治疗能明显缩短带状疱疹受累神经的修复过程,改善临床症状,并且不良反应少.     

红外线联合药物治疗带状疱疹的疗效观察

目的 观察红外线联合药物治疗带状疱疹的疗效。方法将72例带状疱疹患者随机分为治疗组和对照组。治疗组36例,采用药物治疗的同时加用红外线局部照射;对照组36例,采用单纯药物治疗,观察两组疗效进行对比。结果治疗组疗效明显优于对照组,差异有统计学意义（P〈0．01）。结论 红外线存带状疱疹的治疗中能促进渗出吸收,水疱干涸、结痂、消炎、缓解神经疼痛．提高了治愈率,缩短了病程。同时可降低疱疹后遗神经痛的发生率。     

带状疱疹初期疗法与神经痛疗效的相关性研究

目的 探讨带状疱疹初期治疗方法与神经痛疗效的关系.方法 将120例带状疱疹患者随机分为3组,A组给予泛昔洛韦,B组给予泛昔洛韦联合复方甘草酸苷,C组给予阿昔洛韦联合复方甘草酸苷,疗程均为7 d,随访1个月.结果 疼痛缓解和消失时间B组最短,与A、C两组比较差异均有统计学意义(P＜0.05),A、C两组相近(P＞0.05).A、B、C三组痊愈率1周时分别为40.0%、65.0%和37.5%,2周时分别为62.5%、90.0%和70.0%,4周时分别为90.0%、100.0%和97.5%,B组与A、C组差异有统计学意义(P＜0.05).结论 本研究中,泛昔洛韦联合复方甘草酸苷治疗初期带状疱疹疼痛疗效最好.     

Healthcare costs associated with varicella and herpes zoster in Norway

BackgroundNorway does not implement routine vaccination against varicella or herpes zoster. Despite substantial health burden associated with both diseases, their economic impact is not well described. The aim of the present study was to document the healthcare costs associated with both conditions in a Norwegian setting.MethodsWe used registry data about patients’ contacts with primary and specialized healthcare services from 2008 to 2014 to estimate the costs associated with varicella and herpes zoster in the primary and hospital care sector. We calculated the individual costs by treatment facility (general practitioner and emergency primary care clinic) in primary care and by treatment level (inpatient, outpatient or ambulatory treatment) at hospitals.ResultsWe estimate that the annual healthcare cost of patients with varicella and herpes zoster are NOK 85 million (approximately € 9 million). Of the annual costs, 73% are associated with herpes zoster and 27% are due to varicella. The majority (54%) of the total annual cost is represented by patients with herpes zoster treated in hospital.ConclusionVaricella and herpes zoster impose a substantial financial burden on the national healthcare services in Norway. Most of the costs are incurred by herpes zoster, which could be prevented by vaccination.     

耳部带状疱疹的诊治体会

目的探讨耳部带状疱疹早期误诊、漏诊的原因。方法收治耳部带状疱疹患者5例,用局部治疗和全身治疗,辅以中医治疗。结果治愈5例。结论耳部带状疱疹早期防止误诊、漏诊及防治并发症至关重要。     

一针三点脊神经根阻滞法治疗带状疱疹

目的 以一针三点脊神经根阻滞法同时治疗脊柱损伤和疼痛难忍的带状疱疹（Hz）,与其他疗法比较优劣。方法选与Hz相对应的有压痛的脊椎间关节处进针,深达骨膜注入阻滞合剂3ml,然后退针至皮下,针尖刺向有伤痛的同一椎间隙并注药2ml,然后再退针皮下针尖刺向同一节段的椎间孔部位并注药5ml。结果经治42例,与其他疗法的16例对比显示,疗效显著。结论本法止痛迅速,疗效确切,有治疗脊柱损伤和Hz及其后遗神经痛的多重功效和诸多优点。     

Cost-effectiveness of vaccination against herpes zoster and postherpetic neuralgia: a critical review

Objective

The objective of this study was to systematically review cost-effectiveness studies of vaccination against herpes zoster (HZ) and postherpetic neuralgia (PHN).

Methods

We searched MEDLINE and EMBASE databases for eligible studies published prior to November 2013. We extracted information regarding model structure, model input parameters, and study results. We compared the results across studies by projecting the health and economic impacts of vaccinating one million adults over their lifetimes.

Results

We identified 15 cost-effectiveness studies performed in North America and Europe. Results ranged from approximately US$10,000 to more than US$100,000 per quality-adjusted life years (QALY) gained. Most studies in Europe concluded that zoster vaccination is likely to be cost-effective. Differences in results among studies are largely due to differing assumptions regarding duration of vaccine protection and a loss in quality of life associated with HZ and to a larger extent, PHN. Moreover, vaccine efficacy against PHN, age at vaccination, and vaccine cost strongly influenced the results in sensitivity analyses.

Conclusion

Most studies included in this review shows that vaccination against HZ is likely to be cost-effective. Future research addressing key model parameters and cost-effectiveness studies in other parts of the world are needed.