神经阻滞治疗带状疱疹神经痛的回顾性研究

Retrospective study of nerve block in the treatment of herpes zoster neuralgia*

摘要:

摘要 目的：探讨神经阻滞治疗带状疱疹神经痛（Herpes zoster neuralgia, HZN）的疗效。方法：回顾性分析南京大学医学院附属金陵医院疼痛科2018年06月 ~ 2022年06月共153名接受神经阻滞治疗的HZN患者，按带状疱疹病程分为急性期组(Acute Herpetic Neuralgia, AHN)（1 ~ 30天）、亚急性期组(subacute herpetic neuralgia, SHN)（31 ~ 90天）和慢性期组(Postherpetic Neuralgia, PHN)（大于90天）。所有患者均行2次神经阻滞治疗，每次间隔7天。记录患者入院时、出院时、出院后1个月和3个月疼痛视觉模拟评分（Visual Analogue Scale, VAS）、口服药用量、匹兹堡睡眠质量指数( Pittsburgh SleepQuality Index, PSQI)、患者满意度评分（Likert scale）和药物不良反应等。结果：三组患者出院时各项评分均较入院时明显改善（P＜0.05），1个月和3个月时AHN组和SHN组普瑞巴林用量较出院时降低（P＜0.05），阿片类药物用量AHN组在第3个月时较入院时和出院时显著降低（P＜0.001），AHN组有30%的患者在出院后3个月内完全停药，SHN组有8%，PHN组仅有3%。AHN组VAS评分、PQSI评分和Likert评分均较SHN组和PHN组有显著改善，且药物不良反应发生率更低。结论：HZN患者越早行神经阻滞治疗，患者疼痛缓解有效率越高，疼痛缓解越持久，口服药疗程越短，对PHN的发生具有一定预防作用。

Abstract:

Abstract Objective:To explore the efficacy of nerve block in the treatment of Herpes zoster neuralgia neuralgia (HZN).Methods:A total of 153 HZN patients who received nerve block therapy in the pain Department of Jinling Hospital affiliated to Medical College of Nanjing University from June 2018 to June 2022 were analyzed retrospectively.According to the course of herpes zoster, they were divided into acute group (Acute Herpetic Neuralgia, AHN) (1 ~ 30 days), subacute group (subacute herpetic neuralgia, SHN)(31 ~ 90 days) and chronic group (Postherpetic Neuralgia, PHN) (more than 91 days). All patients were treated with nerve block twice with an interval of 7 days.The visual analogue score (Visual Analogue Scale, VAS), oral drug dosage, Pittsburgh sleep quality index (Pittsburgh SleepQuality Index, PSQI), patient satisfaction score (Likert scale) and adverse reactions were recorded before admission, at discharge, 1 month and 3 months after discharge.Results:The scores of patients in the three groups at discharge were significantly better than those at admission (P < 0.05). The dosage of pregabalin in AHN group and SHN group at 1 month and 3 months was lower than that at discharge. The dosage of opioids in AHN group was significantly lower than that at admission and discharge (P < 0.001). 30% of patients in AHN group stopped taking drugs completely within 3 months after discharge. The scores of VAS, PQSI and Likert in AHN group were significantly better than those in SHN group and PHN group, and the incidence of adverse drug reactions was lower.Conclusion:The earlier the patients with HZN are treated with nerve block, the higher the effective rate of pain relief is, the longer the pain relief is, and the shorter the course of oral medication is, which has a certain preventive effect on the occurrence of PHN.