皮神經(jīng)阻滯對帶狀皰疹神經(jīng)痛臨床轉(zhuǎn)歸的影響
發(fā)布時間：2019-05-21 17:34
【摘要】：背景:帶狀皰疹患者出現(xiàn)受累組織和神經(jīng)局部免疫炎性反應(yīng)過度,神經(jīng)末梢出現(xiàn)病理性損傷,帶狀皰疹急性期疼痛程度與外周神經(jīng)末梢及神經(jīng)節(jié)的炎性反應(yīng)和組織損傷程度有關(guān)。對受損皮膚行組織活檢也發(fā)現(xiàn),免疫性炎性反應(yīng)在病變早期對外周神經(jīng)的損害。周圍神經(jīng)的病理性改變及神經(jīng)沖動傳導(dǎo)異常,導(dǎo)致外周和中樞神經(jīng)系統(tǒng)功能發(fā)生各種病理性變化,促成帶狀皰疹后遺神經(jīng)痛的持續(xù)性或多方式的疼痛狀態(tài)。有關(guān)臨床觀察發(fā)現(xiàn)對帶狀皰疹皮損區(qū)進行皮神經(jīng)阻滯可以加快皮損區(qū)的結(jié)痂和愈合過程。 目的:臨床觀察評價在帶狀皰疹急性期通過皮神經(jīng)阻滯是否可有效地抑制外周神經(jīng)免疫性炎性反應(yīng),從而控制帶狀皰疹所致的神經(jīng)源性疼痛。 方法:選取帶狀皰疹病人72人,隨機分為2組:皮神經(jīng)阻滯組(L組,n=36),再將該組分為2組:L1組(n=18,受累皮損病變期)和L2組(n=18,受累皮損愈合期);保守藥物治療組(N組,n=36),再分為N1組(n=18,受累皮損病變期)和N2組(n=18,受累皮損愈合期)。L組應(yīng)用0.3%利多卡因+腺苷鈷胺0.5mg+甲強龍40mg,總量10-15ml,在皮損最嚴(yán)重或疼痛最明顯的皮膚受累區(qū),自神經(jīng)分布近端至遠端進行皮下阻滯;N組常規(guī)應(yīng)用口服抗病毒藥物、維生素B12、鎮(zhèn)痛藥物及在皮損區(qū)外用藥物。觀察項目包括兩方面內(nèi)容:◇不同治療方法對帶狀皰疹皮膚損害期皮損愈合的影響;◇受累神經(jīng)區(qū)不同治療組治療前后疼痛程度及性質(zhì)改變及其與PHN發(fā)病的相關(guān)性分析。 結(jié)果: 一、各組患者一般情況及皮損范圍、疼痛程度、治療前發(fā)病時間等比較無統(tǒng)計學(xué)差異(見表1) 二、不同治療方法對帶狀皰疹急性期皮膚損害愈合的影響 在帶狀皰疹受累皮損病變期應(yīng)用兩種方法治療,比較皮損區(qū)結(jié)痂時間和疼痛緩解程度(見表2),兩組治療時間均為四周;臨床觀察發(fā)現(xiàn): 1、兩治療組自皮疹出現(xiàn)至介入治療的時間比較無統(tǒng)計學(xué)意義(p0.05); 2、不同皮損范圍皮損結(jié)痂時間比較: ①兩治療組組間,相同皮損面積結(jié)痂時間比較顯示,L1組較N1組明顯提前,(P0.05); ②兩治療組組內(nèi),不同皮損面積比較顯示,皮損面積越小,結(jié)痂時間越早,各組皮損范圍1%與2%比較均有顯著性差異(P0.05); ③VAS疼痛評分在兩治療組組間總體比較, L1組較N1組疼痛程度明顯降低,(P0.05); ④兩治療組組內(nèi),不同皮損范圍組比較,皮損范圍越小,疼痛程度緩解越明顯(P0.05)。 三、受累神經(jīng)區(qū)不同治療組治療前后疼痛情況比較(見表3、4、5、6) 1、受累神經(jīng)支配區(qū)疼痛性質(zhì)多為持續(xù)灼痛、痛覺異常、感覺遲鈍和自發(fā)痛。 2、不同治療方法對受累神經(jīng)疼痛性質(zhì)變化影響的總體比較 a)兩種治療方法治療前后比較顯示,疼痛性質(zhì)的改變均有顯著性差異(p0.05)。 b)治療后四周L組和N組總體比較顯示:L組持續(xù)灼痛、痛覺異常、自發(fā)痛比率均有明顯下降(p0.05),感覺遲鈍比率明顯增加(p0.05)。 3、L組和N組總體VAS疼痛評分比較顯示,治療后兩組較治療前疼痛程度明顯降低,L組疼痛程度明顯低于N組,p0.05,有統(tǒng)計學(xué)意義。 4、受累皮區(qū)急性期和結(jié)痂期介入治療后神經(jīng)疼痛性質(zhì)變化的比較 ①L1組和L2組:L1組持續(xù)灼痛比率明顯低于L2組(p0.05),痛覺異常和感覺遲鈍比率無明顯差異,自發(fā)痛比率L2組稍有增加,但無統(tǒng)計學(xué)意義; ②N1組和N2組: N1組持續(xù)灼痛和痛覺異常比率明顯低于N2組(p0.05),感覺遲鈍和自發(fā)痛比率兩組無明顯差異。 5、受累皮損病變期介入治療N1組+L1組與受累皮損愈合期介入治療N2組+L2組療效比較:N1組+L1組持續(xù)灼痛和痛覺異常比率明顯低于N2組+L2組(p0.05);N1組+L1組感覺遲鈍比率無明顯增加,自發(fā)痛比率有顯著減少(p0.05)。 結(jié)論: 1、早期應(yīng)用阻滯治療方法可以有效抑制帶狀皰疹皮損區(qū)免疫炎性反應(yīng),使局部皮損早期結(jié)痂愈合; 2、早期應(yīng)用阻滯治療方法,可以促使疼痛性質(zhì)類型發(fā)生改變,并明顯減低帶狀皰疹受累區(qū)的疼痛程度; 3、兩種治療方法結(jié)果均顯示,皮損面積越小,治療效果越顯著 4、兩種治療方法結(jié)果均顯示,在帶狀皰疹皮損早期介入治療可以更有效地控制疼痛癥狀。
[Abstract]:Background: In the patients with herpes zoster, the involvement of the affected tissues and the local immune inflammatory reaction of the nerve is excessive, pathological damage occurs in the nerve endings, and the degree of pain in the acute stage of the herpes zoster is related to the inflammatory reaction and the degree of tissue injury of the peripheral nerve endings and the ganglion. The tissue biopsy of the injured skin also found that the immune inflammatory reaction was damaged at the early stage of the lesion in the early stage of the lesion. The pathological change of the peripheral nerve and the abnormal nerve impulse conduction cause various pathological changes in the function of the peripheral and central nervous system, leading to the persistent or multi-mode pain state of the postherpetic neuralgia. It is found that the skin nerve block in the area of the skin of the herpes zoster can accelerate the healing and healing process of the lesion area. Objective: To evaluate whether the peripheral neuroimmune inflammatory reaction can be effectively inhibited in the acute phase of herpes zoster by clinical observation, so as to control the neurogenic pain caused by herpes zoster. Methods:72 patients with herpes zoster were randomly divided into 2 groups: skin nerve block group (L group, n = 36), and then the group was divided into two groups: L1 group (n = 18, lesion of affected skin lesion) and L2 group (n = 18, affected skin lesion healing period), and conservative drug treatment group (N group, n = 36), and then into the N1 group (n = 18, the lesion of the affected skin lesion) and the N2 group (n = 18, the higher the affected lesion). In group L, 0.3% lidocaine + adenoid cobalamin 0.5 mg + methylprednisolone 40 mg, total amount of 10-15 ml, the most severe or painful skin involvement area in the skin lesion, the subcutaneous block from the proximal to distal end of the nerve distribution, and the routine application of oral antiviral drugs and vitamins in the N group. B12, analgesic, and out of the skin The effect of different treatment methods on the healing of the skin lesions in the skin of the herpes zoster caused by different treatment methods, and the change of the degree of pain and the nature of the treatment group before and after the treatment of the affected nerve area and the correlation with the onset of PHN sex analysis Results:1. The general situation of the patients and the range of the lesions, the degree of pain, the time of treatment before treatment and the like were not statistically significant. the difference of learning The difference (see Table 1)2. The different treatment methods are acute to herpes zoster. The effects of the period of skin lesion healing on the healing of the skin lesions in the patients with herpes zoster were treated by two methods, and the time and the degree of pain relief in the lesion area were compared (see Table 2), and the treatment time of the two groups are all Four weeks; clinical observations found:1. The time between the two treatment groups from the onset of the rash to the interventional treatment No statistical significance (p0.05);2 The results of the comparison between the two treatment groups and the area of the same skin lesion were shown in this paper. Compared with the N1 group, the area of the lesions of the two groups was significantly advanced (P0.05), and the area of the lesions in the two treatment groups showed that the smaller the area of the lesions, the earlier the junction time, and 1% of the lesions in each group. There was a significant difference between 2% and 2% (P0.05). The overall comparison of the VAS pain score between the two treatment groups, L1 The degree of pain in the group was significantly lower than that in the N1 group (P0.05); in the group of the two treatment groups, the range group of different skin lesions was compared, The smaller the range of lesions, the more obvious the degree of pain (P0.05). Comparison of pain before and after treatment in different treatment groups (see Table 3,4,5,6)1, affected nerve The pain of the dominant region is a persistent burning pain, a hyperalgesia, a dull and spontaneous feeling. Pain.2. The general comparison of the effect of different treatment methods on the change in the nature of the affected nerve pain (a) the two treatment parties The results showed that the changes of pain were significantly different before and after the treatment (p0.05). b) The overall comparison of the groups of L and N after treatment showed that the L group had persistent burning pain, hyperalgesia, and spontaneous pain. There was a significant decrease in the ratio (p0.05), and the rate of hypoesthesia was significantly increased (p0.05). The overall VAS pain scores in the 3, L and N groups were compared and the two groups were treated after treatment. The degree of pain in the L group was significantly lower than that of the N group, and the pain degree in the L group was significantly lower than that of the N group, p0.05, Statistical significance.4. Comparison of the changes in the nature of the neuropain following the interventional treatment of the affected skin region at the acute and junction stage: the ratio of the continuous burning pain in the L1 group was significantly lower than that of the L Group 2 (p0.05) ). There was no significant difference in the ratio of hyperalgesia and the rate of hypoesthesia. There was a slight increase in the ratio of the spontaneous pain to the L2 group, but there was no statistical significance; the N1 and the N2 groups: the N1 group continued. The rate of burning pain and hyperalgesia was significantly lower than that of the N2 group (p0.05). There was no significant difference between the two groups. the hyperalgesia ratio is significantly lower than the n2 group + l2 group ( P0. There was no significant increase in the rate of insensitivity in the group of N1 and L1, and there was a significant decrease in the rate of spontaneous pain (p0.05). 1. The early application of block treatment can effectively inhibit the skin lesions of herpes zoster. Regional immune inflammatory response, and the early junction of the local skin lesions in combination;2, that early application of a block of treatment may cause a type of pain nature to be has changed, and obviously reduces the pain degree of the affected area of the herpes zoster; and 3, the results of the two treatment methods all show that the skin lesion
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R752.12
本文編號：2482264
[Abstract]:Background: In the patients with herpes zoster, the involvement of the affected tissues and the local immune inflammatory reaction of the nerve is excessive, pathological damage occurs in the nerve endings, and the degree of pain in the acute stage of the herpes zoster is related to the inflammatory reaction and the degree of tissue injury of the peripheral nerve endings and the ganglion. The tissue biopsy of the injured skin also found that the immune inflammatory reaction was damaged at the early stage of the lesion in the early stage of the lesion. The pathological change of the peripheral nerve and the abnormal nerve impulse conduction cause various pathological changes in the function of the peripheral and central nervous system, leading to the persistent or multi-mode pain state of the postherpetic neuralgia. It is found that the skin nerve block in the area of the skin of the herpes zoster can accelerate the healing and healing process of the lesion area. Objective: To evaluate whether the peripheral neuroimmune inflammatory reaction can be effectively inhibited in the acute phase of herpes zoster by clinical observation, so as to control the neurogenic pain caused by herpes zoster. Methods:72 patients with herpes zoster were randomly divided into 2 groups: skin nerve block group (L group, n = 36), and then the group was divided into two groups: L1 group (n = 18, lesion of affected skin lesion) and L2 group (n = 18, affected skin lesion healing period), and conservative drug treatment group (N group, n = 36), and then into the N1 group (n = 18, the lesion of the affected skin lesion) and the N2 group (n = 18, the higher the affected lesion). In group L, 0.3% lidocaine + adenoid cobalamin 0.5 mg + methylprednisolone 40 mg, total amount of 10-15 ml, the most severe or painful skin involvement area in the skin lesion, the subcutaneous block from the proximal to distal end of the nerve distribution, and the routine application of oral antiviral drugs and vitamins in the N group. B12, analgesic, and out of the skin The effect of different treatment methods on the healing of the skin lesions in the skin of the herpes zoster caused by different treatment methods, and the change of the degree of pain and the nature of the treatment group before and after the treatment of the affected nerve area and the correlation with the onset of PHN sex analysis Results:1. The general situation of the patients and the range of the lesions, the degree of pain, the time of treatment before treatment and the like were not statistically significant. the difference of learning The difference (see Table 1)2. The different treatment methods are acute to herpes zoster. The effects of the period of skin lesion healing on the healing of the skin lesions in the patients with herpes zoster were treated by two methods, and the time and the degree of pain relief in the lesion area were compared (see Table 2), and the treatment time of the two groups are all Four weeks; clinical observations found:1. The time between the two treatment groups from the onset of the rash to the interventional treatment No statistical significance (p0.05);2 The results of the comparison between the two treatment groups and the area of the same skin lesion were shown in this paper. Compared with the N1 group, the area of the lesions of the two groups was significantly advanced (P0.05), and the area of the lesions in the two treatment groups showed that the smaller the area of the lesions, the earlier the junction time, and 1% of the lesions in each group. There was a significant difference between 2% and 2% (P0.05). The overall comparison of the VAS pain score between the two treatment groups, L1 The degree of pain in the group was significantly lower than that in the N1 group (P0.05); in the group of the two treatment groups, the range group of different skin lesions was compared, The smaller the range of lesions, the more obvious the degree of pain (P0.05). Comparison of pain before and after treatment in different treatment groups (see Table 3,4,5,6)1, affected nerve The pain of the dominant region is a persistent burning pain, a hyperalgesia, a dull and spontaneous feeling. Pain.2. The general comparison of the effect of different treatment methods on the change in the nature of the affected nerve pain (a) the two treatment parties The results showed that the changes of pain were significantly different before and after the treatment (p0.05). b) The overall comparison of the groups of L and N after treatment showed that the L group had persistent burning pain, hyperalgesia, and spontaneous pain. There was a significant decrease in the ratio (p0.05), and the rate of hypoesthesia was significantly increased (p0.05). The overall VAS pain scores in the 3, L and N groups were compared and the two groups were treated after treatment. The degree of pain in the L group was significantly lower than that of the N group, and the pain degree in the L group was significantly lower than that of the N group, p0.05, Statistical significance.4. Comparison of the changes in the nature of the neuropain following the interventional treatment of the affected skin region at the acute and junction stage: the ratio of the continuous burning pain in the L1 group was significantly lower than that of the L Group 2 (p0.05) ). There was no significant difference in the ratio of hyperalgesia and the rate of hypoesthesia. There was a slight increase in the ratio of the spontaneous pain to the L2 group, but there was no statistical significance; the N1 and the N2 groups: the N1 group continued. The rate of burning pain and hyperalgesia was significantly lower than that of the N2 group (p0.05). There was no significant difference between the two groups. the hyperalgesia ratio is significantly lower than the n2 group + l2 group ( P0. There was no significant increase in the rate of insensitivity in the group of N1 and L1, and there was a significant decrease in the rate of spontaneous pain (p0.05). 1. The early application of block treatment can effectively inhibit the skin lesions of herpes zoster. Regional immune inflammatory response, and the early junction of the local skin lesions in combination;2, that early application of a block of treatment may cause a type of pain nature to be has changed, and obviously reduces the pain degree of the affected area of the herpes zoster; and 3, the results of the two treatment methods all show that the skin lesion
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R752.12
【參考文獻】
相關(guān)期刊論文 前6條
1 林獻忠;疼痛、鎮(zhèn)痛與免疫[J];國外醫(yī)學(xué).麻醉學(xué)與復(fù)蘇分冊;2003年02期
2 孫建方,徐秀蓮;帶狀皰疹后遺神經(jīng)痛的治療現(xiàn)狀[J];實用老年醫(yī)學(xué);2004年06期
3 楊亞東;伍津津;畢建軍;魯元剛;朱堂友;;帶狀皰疹后遺神經(jīng)痛178例特征回顧[J];中國臨床康復(fù);2005年37期
4 黃仕榮;;針刺促微循環(huán)鎮(zhèn)痛機制研究與思考[J];中國中醫(yī)藥信息雜志;2006年02期
5 肖紅;李茜;劉慧;文傳兵;孫琳;楊邦祥;;神經(jīng)阻滯治療帶狀皰疹神經(jīng)痛臨床療效觀察[J];實用醫(yī)院臨床雜志;2008年01期
6 張斌;王卓強;何建苗;胡玉東;;抗病毒聯(lián)合皮下及肋間神經(jīng)阻滯治療帶狀皰疹痛[J];中國疼痛醫(yī)學(xué)雜志;2006年03期
，本文編號：2482264
本文鏈接：http://sikaile.net/yixuelunwen/pifb/2482264.html
最近更新
教材專著
