皮内注射亚甲蓝治疗老年胸段中重度带状疱疹

目的探讨皮内注射亚甲蓝治疗老年中重度带状疱疹神经痛及预防带状疱疹后遗神经痛的疗效。方法64例带状疱疹神经痛患者随机分为A、B两组，在抗病毒治疗基础上，A组加用皮内注射亚甲蓝及利多卡因，B组加用皮内注射利多卡因。疗程为10 d，两组在治疗第11、30、60、90天随访，对比分析两组患者的疱疹评价指标、疼痛评价指标、带状疱疹后遗痛发生率、综合疗效方面差异。结果两组患者基线特征相似（P>0.05）。A组止疱时间、结痂时间、脱痂时间均短于B组（P<0.05）。A组治疗后疼痛强度、疼痛缓解时间均短于B组（P<0.05）。带状疱疹后遗神经痛发生率，A组在30 d随访时低于B组（P<0.05），60 d、90 d随访差异无统计学意义（P>0.05）。综合疗效比较，A组总有效率为93.8%，B组总有效率为62.5%，A组疗效优于B组。结论皮内注射亚甲蓝治疗带状疱疹可缩短病程，缓解疼痛，降低带状疱疹后遗神经痛的发生。

Efficacy of intracutaneous methylene blue injection for moderate to severe acute thoracic herpes zoster pain and prevention of postherpetic neuralgia in elderly patients

Objective To evaluate the clinical efficacy of intradermal injection of methylene blue for treatment of moderate to severe acute thoracic herpes zoster and prevention of postherpetica neuralgia in elderly patients. Methods Sixty-four elderly patients with herpes zoster were randomized to receive a 10-day course of intradermal injection of methylene blue and lidocaine plus oral valaciclovir (group A, 32 cases) and intradermal injection of lidocaine plus oral valaciclovir (group B) . Herpes evaluation index, pain rating index, incidence of postherpetic neuralgia, and comprehensive therapeutic effect were compared between the two groups at 11, 30 and 60 days after the treatment. Results The baseline characteristics were comparable between the two groups (all P>0.05). Compared with that in group B, the time for no new blister formation, blister incrustation and decrustation, and pain relief was significantly shortened in group A (P<0.05) with also obviously lower pain intensity after the treatment. The incidence of postherpetic neuralgia was significantly lower in group A than in group B at 30 days (P<0.05), but not at 60 and 90 days after the treatment. The total clinical response rate was 93.8%in group A, much higher than that in group B (62.5%, P<0.05). Conclusion Intradermal injection of methylene blue can effectively shorten the disease course, reduce the pain intensity and prevent the development of postherpetic neuralgia in elderly patients with herpes zoster.