椎旁阻滞联合牛痘疫苗接种家兔炎症皮肤提取物治疗带状疱疹神经痛的疗效观察

摘要

目的:观察单纯药物治疗及联合椎旁神经阻滞治疗胸腰背部带状疱疹神经痛的疗效.方法:选择2009年3月至2010年5月我院门诊及住院的60例经确诊患带状疱疹皮损已痊愈而后持续、剧烈、顽固性疼痛、痛觉过敏、麻木、感觉异常且自然病程1～22月,病变累及范围限于T1～L5节段神经支配区的患者,将其随机分为椎旁阻滞与牛痘疫苗接种家兔炎症皮肤提取物(神经妥乐平,NTP)联合用药组(阻滞组)及单纯NTP组(单药组),每组30例.分别给予静脉NTP制剂7.2NU,每日静滴,连续应用15天.阻滞组在此基础上据疱疹累及的脊神经节段分别给予腰椎旁、胸椎旁神经阻滞治疗,观察患者阻滞及用药后1d、7d、15 d、30 d麻木、痛觉过敏、睡眠障碍的改善情况.结果:阻滞组镇痛有效率90.0％,与单药组镇痛有效率63.3％比较差异显著(P＜0.01),治疗后1、7、15、30天VAS评分,QS评分较治疗前均有改善(P＜0.05),睡眠障碍明显改善(P＜0.05).两组间比较,VAS评分、QS评分、痛觉过敏等症状,阻滞组显著降低(P＜0.05).结论:椎旁神经阻滞联合牛痘疫苗接种家免炎症皮肤提取物治疗带状疱疹神经痛疗效明显优于单纯神经修复药组,且效果持续,副作用小.%Objective: To evaluate the efficacy of paravertebral block combined with neurotropin (NTP) on patients suffered from postherpetic neuralgia in chest or lumbar back region. Methods: 60 patients diagnosed postherpetic neuralgia were randomly divided into two groups. Block group (30 cases) accepted paravertebral block according to Herpes Zoster-involving segment plus neurotropin injection; medicine group (30 cases) accepted 7.2 NU I.v. Alone. VAS of pain, numbness and quality of sleep (QS) were observed at 1 d, 7 d, 15 d, 30 d after the treatment. Results: The rate of pain relief was 90.0% in nerve block group; while 63.3% in contral group. The scores of VAS of QS at 1 d, 7 d, 15 d, 30 d after intervention was improved (P < 0.01) as contrasted to pre-treatment level; It is more obvious in block group (P < 0.01). Improvement of sleep disorders in the block group was more obvious contrast to pre-treatment (P < 0.05). There were significant differences (P < 0.05) between the two groups in pain relief and VAS of QS, hyperalgesia improvement after using never block. Conclusion: Paravertebral block plus NTP on postherpetic neuralgia in chest or lumbar region have more significant effect than medication alone with minor side effects.