低温冲击治疗带状疱疹后遗神经痛的临床观察＊

CLINICAL OBSERVATION ON THE TREATMENT OF POSTHERPETIC NEURALGIA WITH PYPOTHERMIC SHOCK

摘要:

目的 观察低温冲击治疗带状疱疹后遗神经痛(postherpetic neuralgia,PHN)的临床疗效。方法 搜集明确诊断为胸背部(T1～12脊神经支配区)PHN患者50例,性别不限,体重40～90Kg,年龄60～80岁。VAS6～10分,发病时长：1月～1年,晚间睡眠不足4h,红外热像图异常,生活质量低下的患者。用随机数字表法分为对照组A组(n=25例)和治疗组B组(n=25例)。A组：普瑞巴林胶囊1片(75mg) po bid+病损区椎旁神经阻滞治疗,每处椎旁神经处注入0.25%利多卡因2ml(每天一次,持续1周)。B组：低温冲击探头在垂直治疗皮肤表面5～10cm处喷洒高纯度的CO2形成干冰微晶(每天一次,连续1周,必要时加用普瑞巴林胶囊1片 po bid)。两组镇痛补救措施：维持VAS评分≤4分,VAS评分＞4分静脉注射盐酸曲马多100mg。两组均在治疗前T0、治疗后T1(1天) 、T2(5天)、 T3(10天) T4(1月)进行VAS评分、睡眠质量、SF-36健康调查简表(the MOS 36-Item Short Form Health Survey,SF-36)、红外热成像及用药情况监测评估。结果 两组VAS评分均降低,睡眠时间(h)延长,红外热像图有改变,生活质量提高,镇痛用药减少。结论 低温冲击可缓解PHN疼痛,降低VAS评分,改善睡眠和提高SF-36,降低镇痛药物用量,改善皮温异常(红外热像图)。

Abstract:

[Abstact] Objective To observe the clinical effect of hypothermia shock therapy on postherpetic neuralgia.[Methods] A total of 50 patients with thoracodorsal PHN (T1～12 spinal nerve innervation region) were collected. Gender unlimited，Weight 40～90 Kg，Age 60～80,VAS6～10 score,Duration of onset,one month-one year, Sleep less than 4 hours at night, Infrared thermography anomaly, Patients with poor quality of life. Random number table was used to divide the patients into control group A (n=25 cases) and treatment group B (n=25 cases). Group A: Prebalin Capsule 1 Tablet (75mg) orally twice a day and Treatment of paravertebral nerve block in lesion area, 0.25% lidocaine 2ml was injected into each paravertebral nerve(Once a day for a week). Group B: Cryogenic shock wave probe sprays high purity CO2 to form dry ice microcrystals at 5～10 cm of the skin surface treated vertically(Once a day for a week, Add pregabalin capsule 1 tablet Po bid if necessary). Remedial measures of analgesia in two groups: Maintain VAS score less than 4 points, VAS score more than 4 points intravenous tramadol hydrochloride100mg. VAS score, sleep quality, SF-36 scores, infrared thermography changesand medication status were monitored and evaluated before treatment, T1 (1 day), T2 (5 days) and T3 (10 days) T4 (1 month) in both groups.[Results] The VAS scores of both groups were decreased, Extended Sleep Time(h), Infrared thermography changed, Improvement of SF-36 and Decreased use of analgesics.[Conclusion] Low temperature extracorporeal shock wave can relieve PHN pain, Reducing VAS score, Improve Sleep and SF-36,Reduce the dosage of analgesics and improve the abnormal skin temperature (infrared thermography).