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目的观察神经阻滞在临床治疗亚急性期带状疱疹神经痛中的作用。方法 42例亚急性期带状疱疹神经痛的患者,随机分为药物治疗组(A组)和神经阻滞加药物治疗组(B组)。A组常规治疗用药:缓释曲马多50 mg,每12 h口服1次,甲钴胺0.5 mg,每8 h口服1次,腺苷钴胺1 mg,每24 h肌注1次。B组在A组的基础上应用神经阻滞治疗,根据皮肤疱疹和疼痛部位,确定其相应的支配神经给予药物阻滞;配方:2%利多卡因注射液5 ml+腺苷钴胺1mg+倍他米松注射液7 mg+0.9%生理盐水至15 ml,每2周1次。采用视觉模拟疼痛评分(VAS)及匹兹堡睡眠质量指数(PSQI)评分对治疗前及治疗后1周、2周、4周及8周的疗效进行评价。结果两组治疗后8周内VAS评分均较治疗前明显降低(P<0.05),但A组VAS评分下降缓慢,8周时才降至3分以下;而B组在治疗后第1周VAS评分即降至3分以下,且治疗后1~8周B组的VAS评分均明显低于A组(P<0.05)。两组治疗后PSQI评分也均较治疗前明显降低(P<0.05),B组治疗后第1周PSQI评分就开始明显改善,与A组相比,差异有统计学意义P<0.05)。结论合用神经阻滞可以缩短带状疱疹神经痛和疼痛症状解除的时间,提高患者睡眠质量,有助于预防带状疱疹后遗神经痛。
Objective To observe the role of nerve block in the treatment of subacute shingles neuralgia. Methods Forty-two patients with subacute herpes zoster neuralgia were randomly divided into a drug treatment group (group A) and a nerve block plus drug treatment group (group B). A group of conventional treatment medication: tramadol 50 mg, oral once every 12 h, methylcobalamin 0.5 mg, oral once every 8 h, adenosylcobalamin 1 mg, intramuscular injection once every 24 h. Group B was treated with nerve block on the basis of group A, and according to the skin herpes and pain sites, the corresponding dominating nerve was determined to give drug block; formula: 5% 2% lidocaine injection + 1 mg adenosine cobalamin + Mesong injection 7 mg + 0.9% saline to 15 ml every 2 weeks. Visual acuity pain scores (VAS) and Pittsburgh Sleep Quality Index (PSQI) scores were used to evaluate the efficacy of pre-treatment and post-treatment 1, 2, 4 and 8 weeks. Results The VAS scores of the two groups were significantly lower than those before treatment (P <0.05) within 8 weeks after treatment, but the VAS scores of A group decreased slowly and dropped to below 3 points after 8 weeks. In the first week after treatment, VAS score To 3 points or less, and the VAS scores of group B were significantly lower than those of group A (P <0.05) after 1 to 8 weeks of treatment. PSQI scores of both groups were significantly lower than those before treatment (P <0.05). PSQI score of group B began to improve at the first week after treatment, which was significantly different from that of group A (P <0.05). Conclusion Combined nerve block can shorten the time to relieve herpes zoster neuralgia and relieve pain symptoms, and improve the quality of sleep in patients with post-herpetic neuralgia.