5%利多卡因凝胶贴膏联合普瑞巴林在带状疱疹后神经痛治疗中的临床价值*

Clinical value of 5% lidocaine gel patch combined with pregabalin in the treatment of postherpetic neuralgia*YUAN Jiang1,WEN Qi-chen 1 ,TING Yu-xu2 ,PAN Min1,ZHNAG Xiao-rong1, JIE Dai1Δ

摘要:

目的：5%利多卡因凝胶贴膏联合普瑞巴林与单用普瑞巴林治疗带状疱疹后神经痛(postherpetic neuralgia,PHN)的临床疗效、不良反应、皮肤病生活质量评分(Dermatology Life Quality Index ,DLQI)的对比研究。方法：收集南京医科大学附属南京医院皮肤科门诊104例PHN患者,将其采用随机抽签法分成两组。联合治疗组采用5%利多卡因凝胶贴膏联合普瑞巴林治疗,患者在常规普瑞巴林治疗的基础上联合使用5%利多卡因凝胶贴膏贴4周；传统治疗组只使用普瑞巴林进行常规治疗。联合治疗组和传统治疗组均在0、1、2、3、4、8周进行随访。每次随访均要对患者的疼痛缓解情况、临床表现、不良反应和皮肤病生活质量评分等进行综合评估。结果：在数字评价量表(numerical rating scale,NRS)评分方面：在1、2、3、4、8周联合治疗组评分明显低于传统治疗组,且差异具有统计学意义(P＜0.05)。在McGill 疼痛问卷简表( Short－form McGill Pain Question- naire,SF － MPQ)评分方面：联合治疗组SF-MPQ、PPI当前疼痛强度(present pain intensity ,PRI)、视觉模拟评分(Visual Analogue Scale, VAS)、感觉情感评分等在随访终点第8周时均低于传统治疗组,治疗终点与基线的差值进行比较,差异也具有统计学意义(P＜0.05)。在皮肤病生活质量评分方面：两组患者在2、3、4、8周DLQI评分,联合治疗组均优于传统治疗组,差异具有统计学意义(P<0.05)。在普瑞巴林使用总量方面,联合治疗组在3-8周普瑞巴林使用量明显少于传统治疗组,差异具有统计学意义(P＜0.05),可见联合治疗可减少系统用药的总量。在不良反应方面,联合治疗组患者在利多卡因贴膏贴处出现1例(1.85%)皮肤刺激和2例(3.70%)红斑症状,上述不良反应均为轻度的且均在去除贴膏后缓解。两组患者使用普瑞巴林不良反应进行统计学分析,差异具有统计学意义(P＜0.05)。结论：5%利多卡因凝胶贴膏联合普瑞巴林治疗带状疱疹后神经痛镇痛效果更好、未见明显严重副作用,而且可以减少系统用药使用总量,明显降低患者疼痛程度,增加患者治疗信心,改善患者的生活质量,提高患者的依从性,是一种治疗带状疱疹后神经痛安全而有效的新方法。

Abstract:

Objective: To compare the effect, Dermatology Life Quality Index (DLQI) and adverse reactions of lidocaine gel patch combined with pregabalin and pregabalin alone in the treatment of postherpetic neuralgia. Methods： A total of 104 postherpetic neuralgia patients from the Dermatology Department of Nanjing Hospital Affiliated to Nanjing Medical University were collected and randomly divided into two groups:the combined treatment group was treated with lidocaine gel patch combined with pregabalin ; the patients in this group were treated with lidocaine patch for 4 weeks. Traditional treatment group was treated with pregabalin alone. Both the combined treatment group and control group were interviewed at 0, 1, 2, 3, 4 and 8 weeks. The pain relief effect, clinical manifestations, quality of life score and adverse reactions of the patients were comprehensively evaluated at each follow-up. Results: In terms of In terms of numerical rating Scale (NRS) scores, the scores of the combined treatment group were significantly lower than those of Traditional treatment group at week 1-8. The difference was statistically significant (P < 0.05). In terms of quality of life scores, the DLQI scores were statistically different between the two groups at week 2-8 (P＜ 0.05). In terms of Short-form McGill Pain question-Naire (SF-MPQ) score,The SF-MPQ, PPI, VAS, and sensory emotion score ofthe combined treatment group were all lower than those of traditional treatment group at the end of 8 weeks of follow-up, and the difference between the end point and the baseline showed significant statistical difference (P < 0.05). In terms of adverse reactions, the combined treatment group appeared 1 case (1.85%) of skin irritation and 2 cases (3.70%) of erythema at the lidocaine patch , and the above adverse reactions were all mild and relieved after the removal of the patch, and There was no statistical difference between the two groups of patients who took pregabalin in adverse reactions (P＜S0.05). Conclusion: Lidocaine gel patch combined with pregabalin has good analgesic effect and few side effects in the treatment of postherpetic neuralgia. It can significantly improve the quality of life of patients and is a safe and effective method for the treatment of postherpetic neuralgia.