超激光联合芬太尼透皮贴剂治疗老年带状疱疹合并糖尿病

背景:老年带状疱疹合并糖尿病患者易转化为带状疱疹后神经痛,且治疗效果欠佳,而超激光疼痛治疗仪已用于很多疼痛的治疗。目的:观察超激光联合芬太尼透皮贴剂治疗老年带状疱疹合并糖尿病15d的疗效。设计:随机对照观察。单位:暨南大学附属第一医院。对象:选择暨南大学附属第一医院2003/2006收治的合并糖尿病的老年带状疱疹患者30例,均接受常规皮肤科药物治疗,年龄>60岁,目测类比评分>7,且经口服或肌注镇痛剂后疼痛仍非常剧烈者。将30例患者数字表法随机分为超激光组、芬太尼组及超激光 芬太尼组3组,每组10例。方法:①超激光组:采用超激光(点式直线偏振光近红外仪SUPER LASER HA-550,日本东京医研株式会社产品)照射治疗,1次/d,疗程15d。②芬太尼组:单用芬太尼透皮贴剂(商品名多瑞吉,美国强生公司)治疗15d,剂量为2.5mg,每3d更换1次。③超激光 芬太尼组:在超激光组的基础上应用芬太尼透皮贴剂治疗15d。主要观察指标:①疼痛程度:治疗3,15d及停止治疗7d以目测类比评分法评价(得分越高疼痛越重)。②疗效:治疗15d后评估,显效:目测类比评分改善度≥70%;有效:30%≤评分改善度<70%;无效:评分改善度<30%。③不良反应。结果:30例均进入结果分析。①目测类比评分比较:治疗3d后,芬太尼组及超激光 芬太尼组得分低于超激光组(2.35±1.43,2.23±1.35,7.00±0.82,P<0.05);治疗15d后,3组得分均较治疗前明显下降(P<0.05);停止治疗7d后,超激光组及超激光 芬太尼组得分低于芬太尼组(3.01±1.20,2.36±1.49,6.70±0.67,P<0.05)。②疗效:治疗15d后,超激光 芬太尼组显效率较超激光组高(80%,60%,70%,P<0.05)。③不良反应:使用芬太尼透皮贴剂治疗的患者仅出现轻度头晕、嗜睡、恶心呕吐、便秘、排尿困难等不良反应,且在1周内消失;使用超激光患者未出现不良反应。结论:超激光联合芬太尼透皮贴剂可明显提高老年带状疱疹合并糖尿病的显效率,既发挥了芬太尼透皮贴剂长效、强效快速镇痛、使用方便的长处,又发挥了超激光作用确切、不易复发及安全性高无损伤的优势,是一种短程、高效的好方法。

Combined therapy of Super Lizer and Durogesic patch in elderly patients with herpes zoster and diabetes mellitus

BACKGROUND:The main symptoms of herpes zoster (HZ) manifest as pain and skin eruption and the pain, when treated inadequately, may proceed to become post herpetic neuralgia (PHN) which has progressively increasing incidence with age.OBJECTIVE: To observe the effect of combined therapy of super laser and Durogesic patch (transdermal fentanyl) in the treatment of elderly patients with herpes zoster and diabetes.DESIGN: Randomized controlled observation.SETTING: The First Affiliated Hospital of Jinan University.PARTICIPANTS: Thirty (14 males and 16 females) elderly patients of age 62-83 years with concurrent herpes zoster (duration 6-14 days) and diabetes who had received the conventional dermatological and medication treatment but still had persistent pain were selected form the First Affiliated Hospital of Jinan University from 2003 to 2006. All elderly patients were randomly divided into 3 groups with 10 in each group.METHODS: ① Super Lizer group (SL Group): Patients were received Super Lizer (linear polarized near-infrared light) therapy once a day for 15 days. ② Durogesic patch group (DR Group): Patients were received 2.5 mg Durogesic patch once for every 3 days. ③ Combined group (SL+ DR Group): Patients were received both the Super Lizer therapy and the Durogesic patch for 15 days.MAIN OUTCOME MASURES: All patients received the assigned treatment for 3 days and VAS was evaluated before and at the 3rd, 15th day during treatment, also at 7th day after termination of treatment. Visual analogue scales were used to assess the degree of pain and global evaluation were done With pain relief more than 70% rated as excellent, pain relief between 30%-70% rated as effective and pain relief less than 30% rated as ineffective. Adverse effects were also recorded.RESULTS: Thirty patients were all involved in the final analysis. VAS scores of all three groups were significantly decreased after 15-day treatment (P ＜ 0.05); after 3-day treatment, VAS scores of DR group (2.35±1.43) and SL+DR group (2.41 ±1.54) were significantly lower than their respective baselines and that of the SL group (7.00±0.82) (P ＜ 0.05) which showed no significant change from the baseline value. SL+DR group showed significantly higher excellent rating than that of the SL group and DR group (80%, 60%, 70%, P ＜ 0.05) at the end of the 15-day treatment. At 7th days after treatment, VAS scores of SL group (3.01±1.20) and SL+DR group (2.41±1.54) were still significantly lower than that of DR group (6.70±0.67) (P ＜ 0.05) which had returned to the pretreatment level. No serious adverse effects such as respiratory depression were observed in any of the patients. Mild side effects such as dizziness, nausea and vomiting, constipation were observed in the DR and SL+DR groups which usually subsided after a week.CONCLUSION: Combined therapy of SL and DR shows a better pain relief in the elderly patients with herpes zoster and diabetes without significant adverse effects. It provides the advantage of fast onset of effect with the Durogesic patch and the long-term effect of Super Lizer.