静脉滴注利多卡因治疗急性期或亚急性期带状疱疹性神经痛的临床疗效研究

背景　带状疱疹相关性神经病理性疼痛是疼痛科常见病，包括带状疱疹性神经痛（HN）及带状疱疹后神经痛（PHN），严重影响患者的生活质量。疼痛应该在急性期或亚急性期控制好，以降低PHN的发生率。利多卡因作为局部麻醉剂，在临床中应用广泛，目前已有文献报道静脉应用利多卡因可用于治疗顽固性疼痛。目的　探讨静脉滴注利多卡因治疗急性期或亚急性期HN的临床疗效。方法　收集2018年3-10月于南华大学附属第二医院疼痛科住院治疗的急性期和亚急性期HN患者各40例，根据病程及是否静脉滴注利多卡因治疗分为急性期常规治疗组、常规治疗加利多卡因组和亚急性期常规治疗组、常规治疗加利多卡因组，排除10例未完成治疗患者，四组分别有18、20、15、17例。急性期常规治疗组的用药为膦甲酸钠注射液+加巴喷丁胶囊+甲钴胺分散片+阿普唑仑片，急性期常规治疗加利多卡因组的用药为膦甲酸钠注射液+加巴喷丁胶囊+甲钴胺分散片+阿普唑仑片+1%盐酸利多卡因注射液，亚急性期常规治疗组用药为加巴喷丁胶囊+甲钴胺分散片+阿普唑仑片，亚急性期常规治疗加利多卡因组的用药为加巴喷丁胶囊+甲钴胺分散片+阿普唑仑片+1%盐酸利多卡因注射液。分别于治疗前和治疗后1、3、7、14、30、60、90 d评估患者视觉模拟评分法（VAS）和睡眠质量评分法（QS）得分，于治疗前和治疗后7、14、30、60、90 d评估患者抑郁自评量表（SDS）评分，观察患者在治疗期间和治疗后是否出现不良反应。结果　急性期及亚急性期各两组患者不同时间VAS、QS、SDS评分比较，治疗方法与时间存在交互作用（P<0.05），治疗方法及时间主效应均显著（P<0.05）。治疗前急性期常规治疗组与常规治疗加利多卡因组、亚急性期常规治疗组与常规治疗加利多卡因组患者VAS、QS、SDS评分比较，差异均无统计学意义（P>0.05）；治疗后1、3、7 d急性期常规治疗加利多卡因组患者VAS、QS评分低于急性期常规治疗组，治疗后7 d SDS评分低于急性期常规治疗组（P<0.05）；治疗后1、3、7、14、30、60、90 d亚急性期常规治疗加利多卡因组患者VAS、QS评分低于亚急性期常规治疗组，治疗后7、14、30、60、90 d SDS评分低于亚急性期常规治疗组（P<0.05）。四组患者治疗后各时间点VAS、QS、SDS评分均低于治疗前（P<0.05）。四组患者不良反应发生率比较，差异无统计学意义（2/20与1/18、2/17与1/15，χ2=0.009、0.013，P=0.924、0.909）。结论　静脉滴注利多卡因联合常规药物治疗HN的疗效优于传统的常规药物治疗，可明显改善患者的疼痛程度、睡眠质量及抑郁情绪，并未增加不良反应。

Clinical Study of Intravenous Administration of Lidocaine in Acute and Subacute Herpes Zoster-related Neuropathic Pain

Background　Herpes zoster-related neuropathic pain is a common disease in pain management department，including herpetic neuralgia （HN） and post-herpetic neuralgia （PHN），seriously affecting the quality of life of patients.The pain should be controlled during the acute or subacute phase in order to reduce the occurrence of PHN.Lidocaine is widely used in clinical practice as a local anesthetic.It has been reported that intravenous administration of lidocaine can be used to treat intractable pain.Objective　To investigate the clinical efficacy of intravenous administration of lidocaine in the treatment of HN.Methods　Eighty HN inpatients （40 in the acute phase and 40 in the subacute phase） were enrolled from March to October 2018 from Department of Pain Management，the Second Hospital of University of South China.According to the duration of HN and treatment regimen，the acute group was equally divided into acute routine subgroup （n=18） treated with Foscarnet Sodium Injection + Gabapentin Capsules + Mecobalamin Dispersible Tablets + Alprazolam Tablets，and acute lidocaine subgroup （n=20）treated with the above-mentioned four drugs + 1%W/V Lidocaine Hydrochloride Injection，and the subacute group was also equally divided into subacute routine subgroup （n=15）treated with Gabapentin Capsules + Mecobalamin Dispersible Tablets + Alprazolam Tablets，subacute lidocaine subgroup （n=17）treated with the above-mentioned three drugs + 1% W/V Lidocaine Hydrochloride Injection，respectively.The level of pain was measured with the VAS and sleep quality was assessed with the Sleep Quality Scale （QS） at baseline，and at the end of the 1st，3rd，7th，14th，30th，60th，and 90th days of treatment，respectively，and the level of depression was measured with the Zung Self-Rating Depression Scale （SDS） at baseline，and at the end of the 7th，14th，30th，60th，and 90th days of treatment，respectively.Adverse reactions were observed during treatment and after treatment.Results　Both treatment method and duration had a significant interactive effect as well as obvious main effect on the mean scores of VAS，QS and SDS of acute and subacute patients （P<0.05）．Mean scores of VAS，QS and SDS were similar in both acute routine and acute lidocaine subgroups before treatment （P>0.05），but after treatment，mean scores of VAS and QS decreased more significantly at the end of the 1st，3rd，7th days of treatment，and the mean SDS score decreased more significantly at the end of the 7th day of treatment，in the acute lidocaine subgroup （P<0.05）．Both subacute routine and subacute lidocaine subgroups showed similar mean scores of VAS，QS and SDS before treatment （P>0.05），but after treatment，subacute lidocaine subgroup showed more significantly decreased mean scores of VAS and QS at the end of the 1st，3rd，7th，14th，30th，60th，and 90th days of treatment，and more significantly decreased mean SDS score at the end of the 7th，14th，30th，60th，and 90th days of treatment （P<0.05）．Post-treatment mean scores of VAS，QS and SDS measured at each time decreased significantly in all patients compared with baseline（P<0.05）．There was no significant difference in adverse reactions between acute routine and acute lidocaine subgroups （1/18 vs 2/20）（χ2=0.009，P=0.924） and between subacute routine and subacute lidocaine subgroups （1/15 vs 2/17） （χ2=0.013，P=0.909）．Conclusion　Better efficacy was achieved by routine drug treatment in combination with lidocaine in HN patients，by which the pain level，sleep quality and depression level were all improved without increasing adverse reactions.