恩再适注射液肌注治疗LDH术后残余神经痛的临床疗效观察

目的：：观察恩再适注射液肌注治疗LDH(腰椎间盘突出症)术后残余神经痛的临床疗效。方法：选择年龄于40~59岁之间的LDH患者90例(男女各45例)经正规保守治疗4周无效且VAS≥5分患者,行腰4－5或腰5－骶1髓核摘除、椎间融合术后第2周仍存在下肢疼痛或(和)麻木者,按照完全随机等分法分三组、每组30例：A组(维生素B1＋B12注射液组),B组(注射用腺苷钴胺组),C组(恩再适注射液组),通过上述三组治疗3~6周后,观察恩再适注射液组治疗LDH术后残余神经痛的临床疗效。结果：C组(恩再适注射液组)临床疗效显著优于A、B两组。结论：恩再适注射液可显著改善LDH术后残余神经痛症状,具有显著临床疗效。     

临床药师参与1例三叉神经痛治疗的体会

临床药师参与了1例三叉神经痛患者的治疗。通过开展疼痛评估、药学监护,利用药学专业知识提供合理化用药建议和用药指导,并规范了镇痛药物的应用,提高了患者用药的依从性和安全性。     

Occipital neuralgia as a presenting symptom of cervicomedullary dural arteriovenous fistula

Dural arteriovenous fistulas (DAVFs) at the cervicomedullary junction are rare and have a wide variation in presentation. We report a case of occipital neuralgia (ON) as a rare presenting symptom of cervicomedullary DAVF causing intramedullary hemorrhage at the C1 level. It is important to consider the underlying causes of ON, and precise neurological examinations and radiological evaluations are needed.     

化疗引起的神经痛治疗靶点温度选择性TRP通道的研究进展

作为钙离子渗透性的瞬时受体电位(TRP),5种通道(TRPV1~4和TRPM2)被不同的高温激活,两种通道(TRPV1和TRPV8)被低温激活。越来越多的证据表明,TRPA1和TRPM8拮抗剂可预防顺铂、奥沙利铂和紫杉醇诱导的线粒体氧化应激、炎症、冷痛和痛觉过敏。TRPV1在顺铂引起的感觉神经元热痛觉和机械异常中有应答。TRPA1、TRPM8和TRPV2蛋白表达水平主要通过这些治疗方法在背根(DRG)和三叉神经节中增加。主要总结了5种温度调节TRP通道(TRPA1、TRPM8、TRPV1、TRPV2和TRPV4)。     

Trigeminal Neuralgia. Clinical Manifestations of First Division Involvement

A series of 19 patients with what originally had been diagnosed as a first division (V₁) trigeminal neuralgia was collected. The inclusion criteria were severe, rather short-lasting pain attacks within the V₁ area, combined with trigger mechanisms. There were 10 women and 9 men, and the mean age of onset was 57.8 years. Fifteen of 16 with adequate information on attack duration had paroxysms of a "few seconds'" duration or less, whereas 10 patients had paroxysms lasting ≥2 seconds. In an exceptional case, only "more long-lasting" attacks (greater than 30 seconds' duration) were experienced.
In regard to autonomic phenomena, lacrimation was most frequently present (in a total of 8 patients; 3 rather regularly, 5 more irregularly). The combination of lacrimation, conjunctival injection, and rhinorrhea was present in only 2 (of 19), and in neither of them in a major way. Typically, autonomic phenomena occurred during the later stages of disease and during particularly severe and long-lasting attacks. Seven of 14 with adequate information also had nocturnal attacks. Initially, a more or less complete carbamazepine effect was reported by 10 of 13 patients. Precipitation mechanisms were the same as with second and third division tic, but were mainly located within the V₁ area, particularly initially.
A comparison with SUNCT syndrome has been made. SUNCT is a predominantly male disorder, with only exceptional attacks of ≥10 seconds' duration, and generally with attacks of 15 seconds or longer. Autonomic symptoms and signs are more pronounced than in V₁ tic. Carbamazepine generally provides minor, if any, benefit in SUNCT. The present work strongly indicates that the two disorders are essentially different.     

三叉神经慢性缩窄环术后大鼠行为反应与组织学变化的关系

目的:观察慢性缩窄环术前后大鼠对机械刺激的反应阈值与三叉神经的组织学改变,探讨三叉神经痛的发病机制,为治疗等提供实验基础。方法:在大鼠一侧三叉神经分支眶下神经(ION)行缩窄环术(CCI),观察术后不同时段大鼠对机械刺激的反应阈值及三叉神经组织学改变。结果:1.术后2周到8周,在ION支配区域内,大鼠出现痛觉超敏现象,与术前及对照组比较存在显著差异(P<0.01),术后4周开始逐渐恢复,术后12周左右恢复至术前水平。2.术后2周,I0N-CCI区域神经纤维肿胀,髓鞘脱失,正常结构消失;术后4到8周,神经纤维仍有脱髓鞘改变;术后12周神经纤维密度均匀,髓鞘与轴突比例恢复正常。结论:慢性缩窄环术后大鼠对机械刺激的反应阈值与其局部神经纤维脱髓鞘改变密切相关。     

电针联合疏风清热方治疗原发性眶上神经痛的临床观察

目的观察电针联合中药疏风清热方治疗风热上扰型原发性眶上神经痛的临床效果。方法收集2017年3月—2017年7月符合纳入标准的风热上扰型原发性眶上神经痛患者30例(60只眼),随机分为针药组和中药组各15例(30只眼)。中药组予单纯中药治疗,针药组在中药组基础上联合电针治疗,2组均治疗7 d,并随访6个月。记录并观察2组患者治疗前后视觉模拟评分(VAS)及临床疗效,并对相关数据进行统计学分析。结果(1)临床疗效:针药组总有效率93.33%,中药组总有效率66.67%,2组比较差异有统计学意义(P=0.043)。(2)VAS评分:2组治疗后比较,差异有统计学意义(t=-3.209,P=0.002);治疗前后组内比较,针药组(t=88.005,P=0.000)、中药组(t=61.605,P=0.000),差异均有统计学意义。结论电针联合中药自拟方协同治疗风热上扰型原发性眶上神经痛优于单纯中药治疗,可缩短疗程,效果满意,值得在临床中推广应用。     

芬太尼透皮贴剂治疗带状疱疹及疱疹后神经痛的疗效观察

目的 :观察芬太尼透皮贴剂 (多瑞吉 )对带状疱疹及疱疹后神经痛的疗效 ,本文选择了 31例不宜行神经阻滞的病人作为研究对象。方法 :31例病人在抗病毒治疗的同时均使用 2 5 μg/h的多瑞吉作为首次量 ,如疼痛控制不满意 ,临时追加曲马多缓释片 ,下次换贴时再增加至 5 0 μg/h ,观察其对患者疼痛的缓解程度、生活质量的改善以及出现的并发症。结果 :31例病人经多瑞吉治疗后 ,2例因副反应而终止治疗 ,其余患者疼痛明显缓解 ,VAS评分从 8.5 1± 1.12降至 2 .4 7± 1.2 3,生活质量明显提高 ,部分并发症随时间延长而减少。结论 :多瑞吉能有效地控制带状疱疹及疱疹后神经痛 ,改善病人的生活质量 ,随着病人对多瑞吉的适应 ,部分并发症逐渐减少。     

不同剂量糖皮质激素治疗眼带状疱疹的疗效及安全性分析

目的：观察不同剂量糖皮质激素治疗眼带状疱疹的临床效果及安全性。方法：眼带状疱疹患者60例,随机分为两组,各30例,观察组采用强的松60mg qd,疗程7d。对照组采用强的松30mg qd,疗程7d。观察两组的水肿消退时间,疼痛减轻时间,3月后后遗症发生率及激素副作用。结果：两组患者水肿消退时间,疼痛减轻时间存在统计学差异。3月后后遗症发生率与激素副作用均无统计学差异。结论：较大剂量糖皮质激素在消除眼带状疱疹水肿及减轻疼痛方面优于小剂量糖皮质激素,未发现明显毒副作用,对后遗症的发生无明显影响。     

带状疱疹后神经痛多模式镇痛的临床疗效分析

目的 探讨多模式镇痛治疗带状疱疹后神经痛的临床疗效及影响疗效的因素.方法 分析我科2008-01-2011-01 183例带状疱疹后神经痛患者,按照治疗方案随机分4组：药物配合神经阻滞治疗组45例,药物配合超激光治疗组33例,药物配合射频神经毁损治疗组48例,综合治疗组57例.观察并比较各组治疗满意度及术前术后的视觉模拟评分（visual analogue scale,VAS）,突出显示相关因素对治疗的影响.结果 183例患者均好转出院,其中综合治疗组满意率最高,远期疗效最佳.合并糖尿病的患者治疗效果较差.结论 带状疱疹后神经痛的综合多模式镇痛治疗方案是该病最佳的临床治疗方案,合并糖尿病的患者治疗效果尚不理想.