患者自控静脉镇痛技术在重度带状疱疹神经痛的临床应用

Clinical application of patient-controlled intravenous analgesia in severe Zoster-related Neuralgia

摘要:

目的:探讨氢吗啡酮自控静脉镇痛术（Patient Controlled Intravenous Analgesia，PCIA）治疗重度带状疱疹神经痛（Zoster-related Neuralgia, ZRN）的有效性和安全性。方法:回顾性分析2019年1月至2019年12月我院疼痛科住院的22例重度ZRN，同时应用氢吗啡酮PCIA治疗的患者，使用疼痛数字评分量表（Numeric pain rating scale， NRS）评估疼痛，记录PCIA使用前(T0)、PCIA使用第1天(T1)、第2天(T2)、第3天(T3)、转换为阿片类药物缓释剂后第1天(T4)、停用PCIA后第1天(T5)、出院前1天（T6）、出院后1月（T7）、出院后3月（T8）爆发痛（Breakthough Pain, BTP)次数和NRS、静息NRS、24小时吗啡毫克当量、不良反应等。结果:与使用PCIA前相比，PCIA治疗后BTP次数和NRS、静息痛NRS均有下降，差异有统计学意义（P＜0.05）。部分患者出现恶心/呕吐、头晕、便秘、嗜睡等副作用，其中大多数都通过对症治疗后得到缓解。结论:氢吗啡酮PCIA安全有效，是控制重度ZRN患者的一种选择，尤其是等待微创治疗时机的患者或因各种原因不能行微创介入治疗者。

Abstract:

Abstract Objective: Patient-controlled intravenous analgesia（PCIA） has been used widely for its analgesic effect. However, there is scarce knowledge about the efficacy of PCIA for herpes zoster neuralgia. In this study, we sought to investigate the efficacy of PCIA in the treatment of severe zoster-related neuralgia（ZRN）. Methods: A retrospective chart review was conducted on patients with ZRN who had received PCIA at our hospital between January 1, 2019 to December 31, 2019. Numeric pain rating scale(NRS) was used to assess pain. The data was recorded, including the number and NRS of breakthough pain (BTP), resting NRS, 24-hour morphine milligram equivalents, adverse reactions. The time points were recorded include before PCIA use (T0), PCIA use day 1 (T1), day 2 (T2), day 3 (T3), first day after switching to an opioid sustained-release agent (T4), first day after discontinuation of PCIA (T5), 1 day before discharge (T6), 1 month after discharge (T7), 3 months after discharge (T8). All the data were collected from medical records. Results: Compared with those before PCIA, the number and NRS of BTP, resting NRS decreased to varying degrees after PCIA, the difference was statistically significant (P <0.05). The commonly reported complications included nausea/vomiting , dizziness, constipation and somnolence , most of which were managed with symptomatic therapies. Conclusion：PCIA is safe and effective in the treatment of severe ZRN, which can significantly reduce the number and NRS of BTP, resting NRS， and the incidence of adverse reactions was lower.