3种方法对带状疱疹神经痛的疗效对比研究

摘要:目的　对比观察加巴喷丁、皮质激素、神经阻滞法治疗带状疱疹神经痛的效果。方法　随机选取在某院就诊的胸部或背部带状疱疹伴急性期神经痛病人共90例，分成3组，即观察A组（30例）、观察B组（30例）和观察C组（30例），所有患者均采用常规治疗，包括抗病毒药物更昔洛韦、甲钴胺等，观察A组加用加巴喷丁治疗，观察B组联合皮质激素治疗，观察C组联用肋间神经阻滞法治疗。根据VAS量表得分，对比研究各组治疗后1周、治疗后3周疼痛的改善情况、治疗效果及不良反应的发生率。结果　3组在治疗后1周与治疗后3周的VAS均比治疗前有明显的减少，且治疗后3周时比治疗后1周时也有较大减少，差异均有统计学意义，P＜0.05。而3组治疗后组间两两比较，治疗后1周与治疗后3周3组VAS得分差异有统计学意义，进一步进行两两比较后发现，观察A组与B组、观察A组与C组间治疗后的得分差异有统计学意义，观察B组及观察C组治疗后1周及治疗后3周的得分低于观察A组，而观察B组与观察C组间无统计学差异（P＞0.05）。治疗3周后，观察A组治疗总有效率为83.3%（25/30），虽低于其他2组的90.0%（27/30），但差异无统计学意义（χ2＝0.162，P＞0.05）。3组患者均未出现明显不良反应，加巴喷丁组1例患者自述头晕，并有一过性轻度嗜睡，自行缓解。结论　加巴喷丁、皮质激素、神经阻滞法均能较为有效地治疗带状疱疹神经痛，其中皮质激素、神经阻滞法较加巴喷丁改善患者神经痛的效果更为明显。

Efficacy comparison of three therapies on patients with herpes zoster neuralgia

Abstract: Objective This work was to study the effect of different therapies on patients with herpes zoster neuralgia. Methods 90 patients with herpes zoster neuralgia were randomly selected and divided into three groups. Besides the routine treatment, the observation group A received a gabapentin therapy, the observation group B received a treatment by corticosteroids, and the observation group C received the intercostal nerve block therapy. According to the score of VAS scale, comparative study between groups was conducted at 1 week and 3 weeks after treatment for the improvement of pain, treatment effect and the incidence of adverse reactions. Results The VAS of the three groups was significantly reduced at 1 week after treatment, and further reduced at 3 weeks after treatment, and with statistically significant differences (P<0.05). Pairwise comparison showed that statistically significant difference existed between group A and group B, and between group A and group C, with lower VAS score in group B and group C at both time points. No significant difference was observed between group B and group C (P>0.05). The total effective rate of group A at 3 weeks after treatment was 83.3% (25/30), which was slightly less than that of the other two groups (90%, 27/30), but without statistically significance (χ2=0.162, P>0.05). Adverse reactions were not observed in three groups, except that one patient in Gabapentin group complained slight dizziness and mild lethargy which relieve automatically later. Conclusion Gabapentin, orticosteroids and the intercostal nerve block method are all effective in the treatment of herpes zoster neuralgia. Orticosteroids and intercostal nerve block method are more effective than gabapentin.