胸椎旁神经阻滞联合皮下臭氧注射预防老年带状疱疹后神经痛的临床研究

Clinical study of thoracic paravertebral nerve block combined with subcutaneous ozone injection for the prevention of postherpetic neuralgia in the aged

摘要:

目的 评价超声引导下胸椎旁神经节阻滞术(TPVB)联合皮下臭氧注射预防老年带状疱疹后神经痛的临床疗效。方法 120例临床诊断为胸背部带状疱疹(HZ)的老年患者,随机分为4组：基础药物组(A组,n=30),基础药物＋TPVB(B组,n=30),基础药物＋皮下臭氧注射治疗(C组,n=30),基础药物＋皮下臭氧注射治疗＋TPVB(D组,n=30),治疗周期4周。治疗前和治疗后4周采用视觉模拟评分(VAS)、睡眠质量评分(QS)、抑郁自评量表(SDS)评分评估四组的疼痛程度、睡眠质量及抑郁情况；记录治疗前后各组血清C-反应蛋白(CRP)、白介素6(IL-6)等炎症因子水平,皮损愈合时间及随访3月后PHN发生情况。结果 D组治疗后VAS评分(0.27±1.05)、IL-6水平(2.31±0.68 pg/ml)明显低于其他三组,QS评分(3.43±0.73)高于其三他组(P﹤0.01)。D组皮损愈合时间(5.23±0.77天)明显短于其他三组(P﹤0.01),D组3个月后PHN发生率(6.67%)远低于其他三组,差异有统计学意义。结论 胸椎旁神经阻滞术联合皮下臭氧注射能够降低老年急性带状疱疹患者的疼痛、提高睡眠质量,降低IL-6水平,缩短皮损愈合时间,降低PHN发生率。

Abstract:

Objective To assess the clinical efficacy of ultrasound-guided thoracic paravertebral nerve block (TPVB) combined with subcutaneous ozone injection in the prevention of post-herpetic neuralgia for the aged. Methods: The 120 aged patients clinically diagnosed herpes zoster (HZ) were randomly divided into 4 groups: group A with drugs treatment (n=30), group B with drugs treatment and TPVB(n=30), group C with drugs treatment and subcutaneous ozone injection(n=30), and group D with drugs treatment, subcutaneous ozone injection and TPVB (n=30). Treatment cycle was four weeks. Evaluating indicators were visual analogue score (VAS), sleep quality score (QS), visual analogue score (VAS), sleep quality score (QS), and self-rating depression scale (SDS) before and at the end of the 4_th ^week. Inflammatory factors as serum C-reactive protein (CRP) and interleukin 6 (IL-6) were recorded before and at the end of the 3rd month. Results: After four weeks treatment, the VAS score(0.27±1.05) and IL-6(2.31±0.68 pg/ml)in group D were significantly were less than those of the other three groups. The QS score(3.43±0.73) was higher than that of the other three groups (P <0.01). Skin lesion healing period in group D(5.23±0.77 days)was significantly less than that of other three groups (P <0.01). The incidence of PHN in group D(6.67%) was much less than that of other three groups at the 3rd month. Conclusions: Thoracic paravertebral nerve block combined with subcutaneous ozone injection can relieve pain, improve sleep quality, decrease IL-6 level, accelerate skin lesion healing shorten the healing time of skin lesions, and reduce the incidence of PHN in elderly patients.