【作者】 张凯；

【导师】 程智刚；

【作者基本信息】 中南大学 ， 临床医学（专业学位）， 2024， 硕士

【摘要】 目的:带状疱疹后遗神经痛(Postherpetic neuralgia,PHN)的治疗是临床亟待解决的课题。本研究比较超声引导下脊神经阻滞(Spinal nerve block,SNB)和椎旁神经阻滞(Paravertebral block,PVB)治疗带状疱疹后遗神经痛(Postherpetic neuralgia,PHN)的临床治疗效果。方法:本研究纳入的PHN患者采用随机数字表法随机分成超声引导的脊神经阻滞治疗组(SNB组)和超声引导的椎旁神经阻滞治疗组(PVB组)。治疗方法:两组患者均继续口服钙离子通道调节剂(加巴喷丁或普瑞巴林)作为基础治疗。SNB组患者采用超声引导下椎间孔注射0.4%利多卡因2ml,证实脊神经阻滞成功后注射复方倍他米松注射液1ml+甲钴胺针0.5mg(1ml)+0.9%氯化钠注射液1ml配置而成的混合液3ml。PVB组患者采用超声引导下胸椎旁间隙内注射复方倍他米松注射液1ml+甲钴胺针0.5mg(1ml)+1%盐酸罗哌卡因注射液2ml+0.9%氯化钠注射液16ml配置而成的混合液20ml。两组患者均每周治疗1次,连续治疗2周。临床观察指标:记录两组患者治疗前、治疗后2周、治疗后1个月、治疗后3个月、治疗后6个月时视觉模拟评分(visual analogue scale,VAS)和36项简明健康调查问卷(The 36-items Short Form Health Survey,SF-36)得分。记录治疗后2周、治疗后1个月、治疗后3个月、治疗后6个月时治疗总有效率。同时观察治疗期间并发症。结果:筛选2022年1月到2022年12月本院疼痛门诊就诊的77例带状疱疹后遗神经痛患者,其中14例不符合入选标准、4例符合排除标准,59例纳入本研究的PHN患者采用随机数字表法随机分成两组:超声引导的脊神经阻滞治疗组(SNB组,n=29)和超声引导的椎旁神经阻滞治疗组(PVB组,n=30)。PVB组2例患者神经阻滞失败、2例患者中途退出;SBN组3例患者神经阻滞失败,最终两组各26例PHN患者完成本研究。1.两组患者年龄、性别构成、病程、VAS评分、合并的基础疾病均无显著差异(P>0.05)。2.与治疗前比较,治疗后两组患者各时间点VAS评分均显著降低(P<0.05或P<0.01);治疗后1个月、3个月和6个月各时点SNB组患者VAS评分低于PVB组,但无统计学差异(P>0.05)。3.治疗后1个月、3个月和6个月各时点SNB组患者总有效率显著高于PVB组(P<0.05或P<0.01)。4.治疗后2周、治疗后1个月、3个月和6个月各时点心理健康总得分(Mental component summary,MCS)显著高于PVB组(P<0.05),但躯体健康总得分(Physical component summary,PCS)两组间无显著差别(P>0.05)。结论:超声引导脊神经阻滞和椎旁神经阻滞均能安全有效的治疗带状疱疹后遗神经痛,超声引导脊神经阻滞治疗带状疱疹后遗神经痛临床效果优于椎旁神经阻滞。图8幅,表11个,参考文献54篇更多还原

【Abstract】 Objective:The treatment of postherpetic neuralgia is an urgent clinical issue.The objective of this study was to compare the clinical efficacy of ultrasound guided spinal nerve block(SNB)and paravertebral block(PVB)in the treatment of postherpetic neuralgia(PHN).Methods:The PHN patients included in this study were randomly divided into an ultrasound-guided spinal nerve block treatment group(SNB group)and an ultrasound-guided paravertebral nerve block treatment group(PVB group)using a random number table method.Treatment methods:Patients in both groups continued to take oral calcium channel modulators(gabapentin or pregabalin)as the basic treatment.The patients in the SNB group were treated with ultrasound-guided intervertebral foraminal injection of 2ml of 0.4%lidocaine was injected into the intervertebral foramina under ultrasound guidance.After the successful spinal nerve block was confirmed,the 3ml mixture solution of compound Betamethasone injection(1ml)+mecobalamine injection 0.5mg(1ml)+0.9%sodium chloride injection(1ml)was injected into the intervertebral foramen.In the PVB group,20ml of the mixed solution composed of compound Betamethasone injection 1ml+mecobalamine injection 0.5mg(1ml)+1%ropivacaine hydrochloride injection 2ml+0.9%sodium chloride injection 16ml was injected into the thoracic paravertebral space under ultrasound guidance.The patients in both groups were treated once a week for 2 consecutive weeks.Clinical observation index:The visual analogue scale(VAS)and The 36-items Short Form Health Survey(SF-36)of the patients in both groups was recorded before treatment,2 weeks after treatment,1 month,3 months and 6 months after treatment.The total effective rate was recorded 2 weeks after treatment,1 month,3 months and 6 months after treatment,and Complications during treatment were also observed.Results:77 patients with postherpetic neuralgia treated in the pain clinic of our hospital from January 2022 to December 2022 were screened,of which 14 patients did not meet the inclusion criteria and 4patients met the exclusion criteria.59 PHN patients included in this study were randomly divided into two groups using random number table method:Ultrasound guided spinal nerve block treatment group(SNB group,n=29)and ultrasound guided paravertebral nerve block treatment group(PVB group,n=30).In PVB group,2 patients failed nerve block and 2 patients dropped out.Nerve block failed in 3 patients in SBN group,and 26 patients with PHN in each group completed the study.1.There were no differences in age,gender composition,course of disease,VAS score and underlying diseases between the two groups(P>0.05).2.Compared with before treatment,The VAS scores of patients in both groups were significantly decreased at each time point after treatment(P<0.05 or P<0.01).The VAS score of patients in the SNB group were lower than that in the PVB group at 1 month,3 months,and 6 months after treatment,but there was no statistical difference(P>0.05).3.The total effective rate of SNB group was significantly higher than that of PVB group at 1 month,3 months,and 6 months after treatment(P<0.05or P<0.01).4.The MCS score was significantly higher than that of PVB group at 2 weeks,1 month,3 months and 6 months after treatment(P<0.05),but there was no difference in PCS score between the two groups(P>0.05).Conclusion:Both ultrasound-guided spinal nerve block and paravertebral nerve block are safe and effective in the treatment of postherpetic neuralgia.The clinical efficacy of ultrasound-guided spinal nerve block is better than that of paravertebral nerve block in the treatment of postherpetic neuralgia.更多还原