目的 观察氯胺酮用于椎旁阻滞治疗糖尿病周围神经病变的临床疗效.方法 选择40例常规物理疗法效果欠佳的糖尿病周围神经病变患者.随机分为2组(20例/组),治疗(T)组:1%利多卡因加0.5 mg 维生素B12加0.25 mg/kg氯胺酮混合液;对照(C)组:1%利多卡因加0.5 mg 维生素B12混合液.观测患者治疗前、后自觉症状、腱反射、神经传导速度及总有效率.疗程结束随访18个月并统计总复发率.结果 T组症状和体征的总好转率明显高于C组(P<0.05).T组总有效率为97.5%,显著高于C组的79.7%(P< 0.05).随访发现T组疗效维持明显优于C组,C组总复发率为25.2%,显著高于T组的5.6%(P<0.01).结论 椎旁神经阻滞联合亚剂量氯胺酮对糖尿病周围神经病变治疗效果显著且复发率低.%Objective To investigate the clinical curative effect of paravertebral block unification ketamine intervention to treatment diabetic neuropathies. Methods 40 patients accepted conventional physiotherapy, but the therapy was·inefficacy. Then treatment with paravertebral block unification ketamine intervention was performed. Locating upper and inferior sites of the corresponding diseased region homonymy nerve segment and block the nerve root. The sufferers were treated with following two conditions(n= 20), treatment(T) group: treated with 2.5 mL mixing fluid of 1 ％ lidocaine added 0.5 mg VitB12 and 0.25 mg/kg ketamine in each site; control(C) group: treated with 2.5 mL mixing fluid of 1 ％ lidocaine added 0. 5 mg VitB12 in each site. The patients treated once per tridper quintic for one course of treatment. The patients of each group detected the conductive velocity of nerve,simultaneous observation the subjective symptom and changes of tendon reflex and total effective rate at pretherapy and the termination. After the end of course of treatment, both home telephone inquiry and follow up during out-patient service were carried out in 40 cases for 18 months and statistics the total recurrence rate. Results The total effective rate of T group(97.5 ％) was higher compared with that in C group(79.7％) (P＜0.05) ,the total recurrence rate of T group(5.6％) was lower compared with that in C group(25.2 ％) followed up after 18 months(P＜0.01). Conclusion Paravertebral block unification deuto-dose ketamine intervention at patients with diabetic neuropathies can be winning satisfactory therapeutic effect and low recurrence rate.
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