带状疱疹早期硬膜外持续给药的止痛效果及对后遗神经痛发病率的影响

目的 探讨带状疱疹早期硬膜外置管持续给药的止痛效果及对带状疱疹后遗神经痛（PHN）发病率的影响.方法 带状疱疹患者182例随机分为药物组（117例）和联合组（65例）,其中药物组行抗病毒治疗,联合组除抗病毒治疗外,另依据患者带状疱疹所在的部位、疼痛范围及受累神经,选择相应的硬膜外间隙穿刺置管,连接PCA泵,PCA内含0.5％利多卡因300ml,泵速为3～5 ml/h,单次量为2 ml,根据患者主诉症状调整泵入量.用药后每日观察疗效,出院后的第1、3、12个月时随访PHN的发生情况.结果 联合组的止痛起效时间短于药物组,联合组未见PHN发生,药物组PHN的发生率为6.25％（7/112例）,差异有统计学意义（P＜0.05）.结论 带状疱疹早期硬膜外置管持续给药的止痛疗效确切,并可降低PHN的发生率.

Analgesic effect of continuous epidural injection on the early stage of herpes zoster pain and the incidence of postherpetic neuralgia

Objective To explore the analgesic effects of continuous epidural injection on the herpes zoster in early stage and the influence on the incidence of postherpetie neuralgia （PHN）. Methods One hundred and eighty-two patients with herpes zoster were randomly divided into drug group （117 cases） and combined group （65 cases）. Patients in the drug group were received antiviral treatment, and in the combined group were combined with continuous epidural injection according to the shingles site, scope of pain and the affected nerves. PCA was used and the pump contained 0.5 lidocaine 300 ml, back ground infusion 3-5 ml/h, bolus 2 ml was connected. The dose was adjusted according to the patient＇s complaint. The efficacy was observed after the treatment every day, and the incidence of postherpetic neuralgia（PHN）was followed-up at 1st, 3rd, 12th month after dis- charge. Results The analgesic onset time in the combined group was significantly shorter than that in the drug group, and no PHN was found in the combined group, which was significantly lower than that in the drug group （P〈0.05）. Conclusion The efficacy of continuous epidural medication via epidural catheter is definite in the treatment of early stage herpes zoster pain, and can significantly reduce the incidence of PHN.