【摘要】：背景接受抗病毒治療的年齡≥50歲的帶狀皰疹(Herpes Zoster HZ)患者,據(jù)報(bào)道其帶狀皰疹后神經(jīng)痛(Postherpetic Neuralgia PHN)的發(fā)生率仍然高達(dá)25%。而交感神經(jīng)阻滯在緩解HZ急性期疼痛及減少PHN發(fā)生率上,仍有爭議。目的本研究旨在探討早期超聲引導(dǎo)下星狀神經(jīng)節(jié)阻滯(Stellate Ganglion BlockSGB)可否減輕頭頸部HZ患者的急性期疼痛強(qiáng)度、縮短疼痛持續(xù)時(shí)間及減少PHN的發(fā)生率和／或嚴(yán)重程度。方法64例年齡≥50歲的HZ患者隨機(jī)分到L組或S組,每組32例。L組：0.5%利多卡因+1mg維生素B12共5ml行患側(cè)SGB (Group L),S組：生理鹽水+1mg維生素B12共5ml行患側(cè)SGB (Group S)。SGB均在超聲引導(dǎo)下完成,每周兩次。所有患者均口服加巴噴丁1200mg/d,若降低到輕度疼痛,則逐漸降至每日服用600mg。額外鎮(zhèn)痛選用奇曼丁(曲馬多緩釋片)：每次50-100mg,每天兩次,最高劑量不超過400mg,視疼痛程度患者自行服用。記錄以下時(shí)間的加巴噴丁和曲馬多的使用量、疼痛視覺模擬評分(Visual Analogue Scale VAS)及疼痛強(qiáng)度：治療前,治療后第1、2、3、4、6周,第2、3月。記錄疼痛完全緩解的時(shí)間和不良反應(yīng)發(fā)生率。第三個(gè)月評估患者的滿意度和PHN發(fā)生率。結(jié)果兩組患者一般情況比較無統(tǒng)計(jì)學(xué)差異。與S組相比,L組疼痛持續(xù)時(shí)間顯著縮短(P=0.004),各時(shí)間段VAS評分均顯著降低(P0.05),3個(gè)月后PHN發(fā)生率顯著降低(P=0.034)以及患者滿意度顯著增高(P=0.044)。L組加巴噴丁和曲馬多的總用量均顯著低于S組(P0.001)。研究期間無嚴(yán)重不良反應(yīng)發(fā)生,兩組患者不良發(fā)應(yīng)發(fā)生率無統(tǒng)計(jì)學(xué)差異。結(jié)論早期超聲引導(dǎo)下SGB聯(lián)合抗病毒及口服鎮(zhèn)痛藥物(加巴噴丁和曲馬多)治療可顯著降低頭頸部HZ患者急性期疼痛的強(qiáng)度,縮短疼痛持續(xù)時(shí)間,降低PHN的發(fā)生率和提高患者滿意度,值得臨床推廣。
[Abstract]:Background the incidence of (Postherpetic Neuralgia PHN) in patients with herpes zoster (Herpes Zoster HZ) over 50 years old who received antiviral therapy was still reported to be as high as 25%. Sympathetic nerve block is still controversial in relieving pain and reducing the incidence of PHN in the acute phase of HZ. Objective to investigate whether early ultrasound-guided stellate ganglion block (Stellate Ganglion BlockSGB) can alleviate the acute pain intensity, shorten the duration of pain and reduce the incidence and / or severity of PHN in patients with head and neck HZ. Methods 64 patients with HZ 鈮，

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