超早期应用加巴喷丁对带状疱疹性神经痛患者治疗效果及临床转归的研究

Efficacy and Prognosis of Ultra-early Application of Gabapentin for Herpes Zoster Neuralgia

摘要:

目的 研究超早期应用加巴喷丁对带状疱疹性神经痛患者的治疗效果及临床转归。方法 根据发病情况将出疱72小时内就诊的带状疱疹患者纳入对照组(n=30),将初次就诊尚未出疱、具有典型神经痛症状、红外热线图检查示患侧高温区、排除器质性病变、并于出疱后72小时内再次就诊的带状疱疹患者纳入试验组(n=30)。试验组患者于首次就诊时给予加巴喷丁镇痛治疗,明确诊断后给予抗病毒、营养神经治疗；对照组患者确诊后即给予加巴喷丁、抗病毒及营养神经药物对症治疗。两组患者均于治疗前(T0)、治疗第7天(T1)、第14天(T2)、第28天(T3)行简要McGill疼痛问卷评估疼痛程度,在治疗前(T0)、治疗第14天(T2)及治疗第28天(T3)行红外热像图检查,测量患侧与健侧温度差(DT)以反映神经炎性反应程度,评估治疗前后睡眠质量及生活质量,统计神经阻滞及带状疱疹后神经痛(post-herpetic neuralgia,PHN)发生率。 结果 与T0相比,两组患者T1、T2、T3时McGill评分及T2、T3时ΔT明显降低,治疗后睡眠质量及生活质量明显改善,差异有统计学意义。与对照组相应时点相比,试验组患者T1 、T2 时McGill评分较低,T2、T3时ΔT明显下降,T1时睡眠质量及生活质量已明显改善,差异有统计学意义。试验组患者行神经阻滞例数低于对照组,但两组患者PHN发生率无明显差别。 结论 超早期应用加巴喷丁可快速缓解带状疱疹性神经痛患者疼痛,减轻疱疹区域神经炎性反应,提高患者睡眠及生活质量,但未减低带状疱疹后神经痛发生率,具有一定临床价值。

Abstract:

Objective To study the therapeutic efficacy and prognosis of ultra-early application of gabapentin in patients with herpes zoster neuralgia. Methods Patients who diagnosed with herpes zoster present within the first 72 h of vesicle formation were divided into the control group (n=30),patients with neuralgia, high-temperature area in affected side in Infrared Thermal Imaging, excluded other diseases and visited again within 72 h rush onset were divided into the experimental group (n=30). In experimental group,patients were received gabapentin at first visit, and antiviral and neurotrophic drugs after diagnosis with herpes zoster. In control group, patients were received gabapentin, antiviral and neurotrophic drugs immediately. The brief McGill pain scores before the treatment(T0), at 7 days (T1), 14 days (T2) and 28 days (T3) after the treatment were assessed to reflect the pain level and the temperature differences between the affected and contralateral side (DT) were measured by Infrared Thermal Image at T0, T2 and T3 to reflect the neuro-inflammatory. The quality of sleep and life were assessed before and after the treatment, and the occurrence rate of nerve block and post-herpetic neuralgia (PHN) were recorded. Results Compared with T0, the McGill pain scores of patients in two groups at T1、T2、T3 were decreased,the quality of sleep and life were improved obviously after the treatment and there was statistically different. Compared with control group, the McGill pain scores at T1、T2 were lower, and theΔT at T2、T3 were decreased in experimental group, and the quality of sleep and life were improved significantly at T1 and there was statistically different. The incidence rate of nerve block in experimental group was lower than that in control group, but there was no difference of the incidence rate of PHN. Conclusion ultra-early application of gabapentin can relieve the herpes zoster neuralgia, reduce the neuro-inflammatory in the herpetic region, improve the quality of sleep and life, but could not reduce the incidence of post-herpetic neuralgia, which is still meaningful for the clinical treatment.