选择性神经根阻滞对带状疱疹后遗神经痛的影响

目的探讨应用枸橼酸芬太尼选择性神经根阻滞疗法对带状疱疹后遗症神经痛患者疼痛评分影响。方法选择杭州市第三人民医院2013年1—12月收治的73例带状疱疹后遗症神经痛的患者为观察对象,随机分为观察组38例和对照组35例,对照组采用常规药物治疗加止痛药;观察组在常规治疗基础上进行枸橼酸芬太尼选择性神经根阻滞疗法。采用SPSS 13.0统计学软件进行分析,比较2组患者的临床疗效、不同时间点疼痛视觉模拟评分（VAS评分）、疼痛对睡眠的影响（采用匹兹堡睡眠质量指数评分）情况,并记录和观察2组的不良反应。结果观察组的总有效率94.7%明显高于对照组的总有效率65.7%,差异具有统计学意义（P〈0.05）;T0时间点,2组的疼痛VAS评分的差异无统计学意义（P〉0.05）。2组在T1、T2、T3、T4时间点疼痛VAS评分均显著低于同组T0时间点（均P〈0.05）,观察组改善情况明显高于对照组,差异具有统计学意义（P〈0.05）;2组患者治疗后1、2、3和4周的PSQI评分明显低于治疗前,差异具有统计学意义（P〈0.05）,且观察组治疗后1、2、3和4周的PSQI评分显著低于对照（P〈0.05）;且无明显的不良反应。结论应用枸橼酸芬太尼选择性神经根阻滞疗法对带状疱疹后遗症神经痛患者是安全可靠的,不但可以有效地减少疼痛的产生,也可以有效的改善疼痛对睡眠的影响,值得临床推广。

Effect of selective nerve root block therapy on postherpetic neuralgia

Objective To explore the application of selective nerve root block（SNRB） therapy with fentanyl citrate in relieving the pains of patients with postherpetic neuralgia（ PHN）. Methods Total 73 cases of PNH in our hospital from January 2013 to December 2013 were selected and assigned randomly into observation group（38 cases） control group（35cases）. The control group received the routine medication treatment and antalgesic,while the observation group received SNRB therapy with fentanyl citrate based on the routine treatment. The clinical efficacy,pain visual analogue score（ VAS score） at different time points,effect of pain on sleep（Pittsburgh sleep quality） and PSQI scores,and the incidence of adverse reactions were compared between the two groups. SPSS 13. 0 was used for the data analysis. Results The total effective rate of the observation group（94. 7%） was significantly higher than that（65. 7%） the control group,the difference was statistically significant（P〈0. 05）;At T0 time point,there was no significant difference in pain VAS score between the two groups（P 〉0. 05）. The pain VAS score at T1,T2,T3 and T4 time points were significantly lower than that at T0 point in both groups（P〈0. 05）,and the observation group improved significantly（P〈0. 05）. PSQI score after 1,2,3 and4 weeks of treatment was significantly lower than that before the treatment in both groups,and the difference was statistically significant（P〈0. 05）;and the scores at different time points were lower in the observation group as compared to the control group（ P〈0. 05）;and there was no significant adverse reactions. Conclusion The selective nerve root block therapy with fentanyl citrate in relieving the pains of patients with postherpetic neuralgia was safe and reliable,it can also improve the influence of pains on the sleep of patients,and worthy of promotion in clinic.