顽固性眼带状疱疹后神经痛临床治疗及随访观察

CLINICAL TREATMENT AND FOLLOW UP OF INTRACTABLE PAIN INDUCED BY POSTHERPETIC NEURALGIA OF EYE BRANCH OF TRIGEMINAL NERVE

摘要:

目的 :研究顽固性眼带状疱疹后遗神经痛合并眼球前段炎症的临床治疗效果及随访资料分析。方法 :使用聚肌胞、弥可保和地塞米松注射液眼眶缘注药 (每次 1.5～ 2 .0ml,隔日一次 ,五次为一疗程 )加口服抗抑郁药等 (阿米替林片 2 5～ 5 0mg /日 ,奇曼丁 10 0～ 2 0 0mg/日 ,舒乐安定 1～2mg/日 )的联合治疗方法。使用治疗前、后自身对照方法搜集资料 ,使用国际通用的视觉模拟评分法 (VAS)和改良汉米尔顿抑郁量表 (HAMD)评定病人的疼痛和情绪变化。结果 :大多数病人在治疗后能达到立即缓解剧烈疼痛的作用 ,在经过 3次治疗后能有效控制自发性剧烈疼痛 ,病人情绪明显改善。治疗前、后VAS和HAMD分别为 7.8:2 .4和 2 1.4 :8.6 ;经过半年左右的随访 ,疗效基本稳定 ,病人的工作或家务能力显著改善 ,自我评价基本满意 (P <0 .0 1,P <0 .0 5 )。本组病例治疗过程中未发生任何明显的副作用。结论 :使用聚肌胞、弥可保注射液眼眶缘注药加口服抗抑郁药治疗眼前段炎症及后遗神经痛取得了较为满意的临床效果。本方法简单、有效、安全实用。

Abstract:

Objective: To investigate the therapeutic effects and follow up results of the relief of intractable pain produced by postherpetic neuralgia of eyes with anterior uveitis. Methods: The solution of poly inosinic cytidylic acid (poly I:C), dexamethasone or mecobalem is used to inject along with superior margine of orbit (1.5 to 2 ml, qod, 5 times for one treatment duration) combined with oral amitriptyline 25 to 50mg, tramacotin 100 to 200 mg and serozepam 1 to 2 mg per day. VAS and HAMD are used as pain scale and mood scale. Results: The automatic lacerating pain of most of patients was quickly stopped after first injection treatment and disappeared after 3 times treatment. VAS was decreased from 7.8 to 2.4 and HAMD from 21.4 to 8.6 ( P <0.01, respectively). Therapeutic effects were stable after 6 months follow up and the ability of returning work or doing family work is also remarkably improved, self comment of patients were well too ( P <0.05 respectively). Few side effects or complications were found during treatment. Conclusion: The method of injecting along with superior margine of orbit with solution of poly I:C, dexamethasone and mecobalem combined with oral anti depression agent is effective, safe and applyable.