神经阻滞治疗带状疱疹疼痛73例临床分析

目的 观察神经阻滞时机与控制带状疱疹疼痛及预防后遗神经痛的关系.方法将73例病程〈15 d且采用数字评分法（NRS）评分≥6分的患者,按病程分为Ⅰ组（病程≤7 d,37例）和Ⅱ组（病程〉7 d,36例）.两组经常规治疗同时行责任神经阻滞及皮损区浸润治疗：颈椎、胸椎、腰椎椎旁神经分别用浓度为0.40%、0.40%、0.80%利多卡因液5 ml,加维生素B12 0.25 mg、地塞米松0.5 mg;神经丛和神经分支阻滞采用浓度为1.00%利多卡因液,加维生素B12 0.50 mg、地塞米松2.0 mg,剂量随部位而定;局部浸润用0.25%的利多卡因40 ml.比较两组治疗前、整个疗程完成后3 d时及1个月复诊时NRS评分的变化以及Ⅰ、Ⅱ组治愈率、有效率及治疗次数的差异.结果Ⅰ组、Ⅱ组患者经神经阻滞治疗后NRS评分均有明显下降,整个疗程结束后3 d时,Ⅰ组从治疗前（7.37±1.43）分下降为（0.92±0.40）分（t=27.30,P〈0.01）,Ⅱ组由（7.16±1.41）分下降为（0.75±0.39）分（t=29.62,P〈0.01）;Ⅰ组、Ⅱ组患者治愈率、有效率及治疗次数差异无统计学意义;治疗1个月后73例患者NRS评分均〈3分.结论 神经阻滞能有效控制带状疱疹早期疼痛,可有效预防后遗神经痛的发生.

Nerve block for management of early and postherpetic neuralgia in patients with herpes zoster

Objective To assess the application of nerve block in management of early and post- herpetic neuralgia （PHN） in patients with herpes zoster. Methods Seventy three patients with herpes zoster were enrolled, the course of disease was within 15 d and the numeric rating scale （NRS） scores were 〉t6. The course of disease was ≤7 d in 37 patients （ group Ⅰ ） , the course was 〉 7 d and 〈 15 d in 36 patients （group Ⅱ ）. After the conventional therapy, all the patients were treated with nerve block. The cervical, thoracic, lumbar paravertebral nerve blocks were performed by injecting 5 ml lidoeaine in the concentrations of 0.40% , 0. 40% , 0. 80% respectively, with 0. 25 mg vitamin B12 and 0. 5 mg dexamethasone. For the nerve plexus and nerve branch blockages, the concentration of lidocaine was 1.00% , with 0. 50 trig vitamin B12 and 2. 0 mg dexamethasone, the dosage varied depending on the infection sites. Furthermore, 40 ml lidocaine with a concentration of 0. 25% was used for the local infiltration. The NRS scores were documented before and after the treatment, and the differences in cure rate, effective rate and frequency of treatment were compared between group Ⅰ and group Ⅱ. Results The scores of NRS decreased significantly in two groups after the treatment of nerve block, at d3 after the treatment, the score of NRS in group Ⅰ was reduced from 7.37 ± 1.43 to 0. 92 ± O. 40 （t = 27.30, P 〈 0. 01 ）, and the score of NRS in group Ⅱ was reduced from 7. 16 ± 1.41 to 0. 75 ± 0. 39 （ t = 29. 62, P 〈 0. 01 ）. There were no significant differences in cure rate, effective rate and frequency of treatment between two groups. The NRS scores of all patients were 〈 3 one month ＇after treatment. Conclusion Nerve block has a satisfactory efficacy in treatment of acute herpes zoster, it can also effectively prevent the occurrence of postherpetic neuralgia.