不同方法肋间神经阻滞治疗带状疱疹神经痛疗效比较

目的:观察不同方法肋间神经阻滞治疗带状疱疹神经痛的阻滞成功率、镇痛效果和并发症情况。方法:胸背部带状疱疹伴神经痛患者93例随机分成两组,超声组和对照组,观察治疗后1、2、4、8周镇痛效果和不同疼痛缓解度比例及第8周生活质量评分。结果:超声引导下完成所有48例超声组患者后入路肋间神经阻滞,阻滞后15 min测定感觉阻滞区完全覆盖皮损疼痛区域。32例对照组患者采用传统方法完成后方入路肋间神经阻滞,13例患者肋骨触摸不清改为外侧入路完成阻滞,其中6例阻滞不完全。两组患者阻滞后均未出现胸闷或呼吸困难等表现。与治疗前比较,治疗后各观察时间点视觉模拟评分(visual analogue scale,VAS)均显著降低(P<0.01),组间比较存在显著差异(P<0.05)。治疗后第8周饮食、睡眠、情绪、日常生活、交际和生活兴趣等生活质量评分均显著降低(P<0.05或P<0.01),组间比较存在统计学差异(P<0.05)。治疗后超声组显效率明显高于对照组(P<0.01)。结论:在超声引导下行后路肋间神经阻滞术安全有效,准确率高,是治疗带状疱疹性神经痛有效的一项新技术。

A COMPARISON OF DIFFERENT METHODS OF INTERCOSTAL NERVE BLOCK FOR POSTHERPETIC NEURALGIA

Objective: To observe the achievement ratio of different methods of intercostal nerve block for treatment of postherpetic neuralgia(PHN),the effectiveness of analgesia and complicati-ons related to nerve block.Methods: Ninety-three patients with PHN at the chest-back were included in this study.Patients were divided into 2 groups: ultrasound-guided group and control group.The success rate of nerve block and complications were recorded.Pain scores and quality of life scores were also meas-ured at 1,2,4 and 8 weeks after the end of treatments.Results: Ultrasound imaging confirmed the ribs and intercostal space clearly and the procedure were all successful.No any complication of dyspnea or difficu-lty in breathing caused by nerve block in this study.Pain was relieved 15 minutes late after nerve block under the ultrasound.Compared with pretherapy,visual analogue scale(VAS) were significantly less at each times after 8 week post-treatment in two groups(P < 0.01).Compared with the control group,the VAS were significantly less at each times after 8 week post-treatment(P < 0.05).Compared with pretherapy,the quality of life scores were significantly less at each times after 8 week post-treatment in two groups(P < 0.05,P < 0.01).Compared with the control group,the quality of life scores were significantly less at each times after 8 week post-treatment(P < 0.05).The excellent rate in ultrasound group was higher than that in control group(P < 0.01).Conclusion: The approach of posterior intercostal nerve block under ultrasound-guided is a safe and effective way for treating PHN.