硬膜外和椎旁神经根注药法对带状疱疹后遗神经痛的疗效观察

带状疱疹后遗症神经痛（ＰＨＮ）是急性带状疱疹痊愈４￣６周后患区留有疼痛，它的诊断并不困难，但共疼痛程度剧烈，持续时间长达３￣５年或更长，患者长期遭受疼前的折磨。，生活质量下降。本文报告３４例（平均年龄６７．８岁）胸腰段ＰＨＮ患者使用硬膜外（ＥＡ）和椎旁（ＰＶＩ）注药两种方法缓解疼痛的对比分析结果。ＥＡ组优良为２９．４％，总有效率为５２．９％；ＰＶＩ组优良率为７０．６％，总有效率为８８．２％，两组经     

普瑞巴林和加巴喷丁辅助性治疗带状疱疹后神经痛的临床研究

目的比较普瑞巴林和加巴喷丁治疗带状孢疹后神经痛（PHN）的临床效果和安全性。方法按自愿原则将168例患者分为A、B、C、D四组,各42例。A组给予安慰剂治疗;B组给予普瑞巴林治疗,维持治疗每日225mg;C组给予普瑞巴林治疗,每日375mg;D组给予加巴喷丁治疗。连续治疗8周后,比较治疗前、后的疼痛程度评分（VAS）变化、睡眠障碍指数（SPI）变化,并评估重点睡眠干扰评分（EMSIS）、疗效和不良反应发生率。结果各组VAS、SPI、EMSIS均明显优于A组,但不良反应发生率要高于A组,差异均有统计学意义（P〈0．05）。C组治疗后的VAS、SPI、EMSIS优于B组,差异有统计学意义（P〈0．05）,但是两组在大部分不良反应发生上差异无统计学意义（P〉0．05）;D组VAS评分和大部分不良反应发生率与B组比较,差异有统计学意义（P〈0．05）,但是在SPI和EMSIS方面差异无统计学意义（P〉0．05）。D组在VAS评分、SPI、EMSIS和大部分不良反应发生上与C组相比,差异有统计学意义（P〈0．05）。A、B、C、D四组的治疗有效率分别为64．29％、90．48％、92．86和73．81％,治疗优良率分别为21．43％、71．43％、83．33％和54．76％。C组治疗有效率明显好于A、D组,治疗优良率明显好于A、B、D组（P〈0．05）。结论相比于安慰剂和加巴喷丁,普瑞巴林在PHN治疗中具有更好的疗效,可以显著改善患者的疼痛程度评分,减轻疼痛对睡眠的干扰。为了提升治疗有效率,剂量宜选择每日375mg,分3次口服;但是,普瑞巴林的不良反应发生率较高;在临床运用中,必须注意不良反应的观察和控制。     

软件面积测算法评定阿霉素椎旁治疗带状疱疹后遗神经痛的疗效研究

目的:运用创新的软件面积测算法,与常规的VAS评分法比较,评定阿霉素椎旁阻滞治疗带状疱疹后遗神经痛的疗效及疾病进程的变化特点。方法:选取带状疱疹后遗神经痛患者50名,随机分为对照组与实验组,确定相应的穿刺脊椎阶段,在C形臂和神经刺激仪引导下,行椎旁穿刺。对照组每个阶段给予0.5%利多卡因2ml,甲基强地松龙10mg/1ml;实验组依次注入甲基强地松龙10mg/1ml及1%阿霉素1ml。用软件面积测算法测定治疗前与治疗后第1,3,7,14,30d疼痛面积大小,及视觉模拟(VAS)评分。结果:实验组与对照组VAS评分、疼痛面积比较除第一天外皆有显著差异(P<0.01);实验组面积数值变化呈明显下降趋势;实验组组间面积两两比较第1天与第30天比较无差异(P>0.05),余皆有显著差异(P<0.01)。结论:软件面积测算法所得面积数值变化趋势能反映阿霉素作用的有效性与顺时性效应,比较客观准确地反映治疗后疼痛减轻程度和疾病变化特点。     

Follow-up of clinical efficacy of iontophoresis therapy for postherpetic neuralgia (PHN)

A great variety of therapies have been attempted for PHN, including pharmacotherapy and physical therapy. However, there has been no decisive treatment, and reports of the clinical efficacy of all available therapies have been rather controversial. Almost all studies conducted so far have looked only at short-term therapeutic efficacy, and only a few investigators have conducted long-term observations or studies on long-term outcome. We followed up the clinical efficacy of iontophoresis therapy using lidocaine and methylprednisolone in 197 PHN patients. Monitoring conducted for an average of 4 years after completion of the treatment showed that pain remained unchanged or improved compared to pain observed upon completion of the treatment in 90.4% of patients. Although 42.6% of patients were still continuing some treatment, 90.9% were found to be able to take care of themselves. Findings obtained were reviewed and discussed from various viewpoints. Our findings showed that iontophoresis therapy is not only effective at the end of the treatment, but its efficacy is maintained over a long period of time, indicating that it is clinically very useful for the treatment of PHN.     

Risk Factors for Herpes Zoster: A Systematic Review and Meta-analysis

Objective

To systematically review studies examining risk factors for herpes zoster (HZ).

Incidence and costs of herpes zoster and postherpetic neuralgia in German adults aged ≥50 years: A prospective study

Objectives

Herpes zoster (HZ) mainly affects elderly people and immunocompromised individuals. HZ is usually characterized by a unilateral painful skin rash. Its most common complication, postherpetic neuralgia (PHN), may cause chronic debilitating pain. This study aimed to estimate the HZ incidence in individuals aged ≥50 years in Germany, the proportion of PHN and the economic burden.

带状疱疹后遗神经痛(HPN)中药治疗现状

带状疱疹后遗神经痛(HPN)是临床治疗较棘手疾病之一。本文检索近年来的医学文献,归纳有关中药治疗带状疱疹后遗神经痛的临床研究报道得出结论:中药治疗HPN疗效显著,在通络止痛的基础上各有侧重,概括为以下三个方面:虚(气虚、阴血虚、阳虚)、郁(气郁、血瘀)、湿(寒湿、湿热),并予以归纳论述,供同行们参考。     

Shingles vaccine

Importance of the field: Herpes zoster or shingles is a condition with the potential to result in severe debilitation. It affects approximately 10 – 30% of the population. Until recently there were only treatments to shorten the duration and lessen the symptoms of herpes zoster, but no practical or approved method of prevention for susceptible immunocompetent adults. The live attenuated zoster vaccine (Zostavax^®, Merck & Co., Inc.) is effective in preventing shingles in individuals 60 years of age and older and recommended by the Center for Disease Control's (CDC) Advisory Committee for Immunization Practices (ACIP).

Areas covered in this review: Literature related to the live attenuated zoster vaccine is reviewed from its beginnings in the early 1970s through to the present.

What the reader will gain: Background information on herpes zoster and up to date information on the live attenuated zoster vaccine including pharmacology, efficacy and safety are covered. New areas of research in zoster vaccination are also discussed.

Take home message: The live attenuated zoster vaccine is an effective and well-tolerated method of preventing zoster and the potentially debilitating sequelae and is recommended for immunocompetent patients 60 years of age and older. Ongoing clinical trials are investigating new means of effective prevention.     

复方甘草酸苷联合阿昔洛韦、神经妥乐平治疗带状疱疹神经痛的疗效

目的:观察复方甘草酸苷联合阿昔洛韦、神经妥乐平治疗带状疱疹后遗神经痛(postherpeticneuralgia,PHN)的临床效果。方法:选取门诊2006年5月～2009年3月收治的130例PHN患者,按照随机数字表法随机分为观察组(复方甘草酸苷联合阿昔洛韦、神经妥乐平治疗组)和对照组(氨酚曲马多片联合卡马西平治疗组)各65例,两组患者连续治疗8周(2个疗程)后比较临床疗效及不良反应情况。结果:(1)观察组基本治愈36例,显效21例,总有效率为87.7%;对照组基本治愈28例,显效14例,总有效率为64.6%。两组患者总有效率比较差异有统计学意义(χ2=17.546,P<0.01)。(2)两组患者治疗前VAS评分相似,治疗2周后观察组改善较对照组明显(P<0.05);治疗4周、8周后观察组改善较对照组更加显著(P<0.01)。(3)两组患者治疗2、4周时疼痛缓解时间比较差异无明显统计学意义(P>0.05);治疗2、4周时镇痛维持时间差异均有统计学意义(P<0.01)。(4)观察组出现面色潮红1例,恶心1例,无血清钾下降、血压升高、休克等不良反应;对照组出现头晕2例。结论:复方甘草酸苷联合阿昔洛韦、神经妥乐平治疗带状疱疹后遗神经痛(PHN)效果理想,可以显著提高疼痛缓解率、延长疼痛缓解时间、提高治疗效果,且临床用药安全,值得推广应用。