庆大霉素与曲安奈德治疗原发性三叉神经痛的早期疗效对比研究

目的 比较庆大霉素与曲安奈德用于原发性三叉神经痛的治疗效果.方法 将40例原发性三叉神经痛患者随机分为两组,每组各20例,分别用庆大霉素(庆大霉素组)和曲安奈德(曲安奈德组)进行三叉神经外周支阻滞.采用视觉模拟评分(VAS)评定患者的疼痛程度和治疗效果.分别记录治疗前、连续5周(每周1次)的注射前以及治疗结束后1、2、3个月的VAS,并记录治疗期间出现的不良反应.结果 两组治疗后的VAS与治疗前相比均出现显著性降低(JP<0.01).在治疗后3周内,庆大霉素组的VAS显著高于曲安奈德组(P<0.05或<0.01);治疗结束后2、3个月.庆大霉素组的VAS显著低于曲安奈德组(P<0.01).治疗后2周内,庆大霉素组治疗有效率显著低于曲安奈德组(P<0.01).治疗结束后2、3个月庆大霉素组的临床治愈率(70%和60%)显著高于曲安奈德组(15%和5%).结论 与曲安奈德治疗效果相比,采用庆大霉素进行三叉神经外周支阻滞,避免了激素相关的药物不良反应,具有镇痛时间长、可多次重复的优势,庆大霉素发挥抑制疼痛作用的起效时间较曲安奈德慢,而抑制疼痛的持续时间较曲安奈德长.

A comparative study of gentamicin and triamcinolone acetonide for the treatment of primary trigeminal neuralgia

Objective To observe the therapeutic effects and adverse events of gentamicin and triamcinolone acetonide on primary trigeminal neuralgia. Methods Forty patients with primary trigeminal neuralgia were allocated into two groups to receive a peripheral nerve block with lidocaine combined with gentamicin (gentamicin group) or triamcinolone aeetonide (triamcinolone acetonide group), respectively,once a week for 5 weeks. The pain intensity were assessed using visual analogue scale (VAS) before treatment and once a week just prior to every treatment, continued to make such assessment every month until 3 months after treatment. The pain relief rate and the occurrence of adverse events were also evaluated.Results The VAS of patients in two groups decreased significantly after treatment (P < 0.01). Compared with triamcinolone aeetonide group, the VAS in gentamicin group were higher during the early 3 weeks after treatment (P< 0.05 or < 0.01). At the observing point of 2, 3 months after treatment, the VAS in gentamicin group were lower than that in triamcinolone acetonide group(P< 0.01). The effective rate in gentamicin group was lower than that in triamcinolone acetonide group during the early 2 weeks after treatment, the clinical cure rate in gentamicin group was higher than that in triamcinolone aeetonide group at the observing point of 2, 3 months (70% and 60% vs 15% and 5%). Conclusion Compared with the triamcinolone aeetonide, the therapy of the gentamicin has slower onset time and longer sedative duration, has no corticosteroids-related side effect, and also has the possibility of repeat blocking time after time.