超声引导下椎旁神经阻滞联合利多卡因凝胶贴膏治疗带状疱疹后神经痛疗效观察

王一一; 李晓红; 刘鹏; 王雅辉; 林学武

doi:10.16766/j.cnki.issn.1674-4152.002893

超声引导下椎旁神经阻滞联合利多卡因凝胶贴膏治疗带状疱疹后神经痛疗效观察

doi: 10.16766/j.cnki.issn.1674-4152.002893

蚌埠医学院第一附属医院麻醉科，安徽蚌埠 233004

基金项目:

安徽省教育厅卓越人才培养创新项目 2020ZYRC104

详细信息

通讯作者:
林学武，E-mail：pain2009@126.com

中图分类号: R752.12R614.4
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出版历程
- 收稿日期: 2022-05-31
- 网络出版日期: 2023-04-19

Efficacy observation of ultrasound-guided paravertebral nerve block combined with lidocaine gel plaster in the treatment of postherpetic neuralgia

Department of Anesthesiology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的分析超声引导下椎旁神经阻滞联合利多卡因凝胶贴膏治疗胸背部带状疱疹后神经痛的临床疗效及安全性。方法选择2020年10月—2021年12月蚌埠医学院第一附属医院疼痛科收治的80例胸腰段带状疱疹后神经痛患者，按照随机数字表法分为对照组和治疗组，每组40例。对照组采取超声引导下椎旁神经阻滞治疗，治疗组采取超声引导下椎旁神经阻滞联合利多卡因凝胶贴膏治疗。比较2组治疗前(T0)及治疗1周后(T1)、2周后(T2)、3周后(T3)、4周后(T4)、8周后(T8)的视觉模拟评分(VAS评分)和匹兹堡睡眠质量指数(PSQI)，比较2组普瑞巴林使用剂量和不良反应发生率。结果治疗组T1、T2、T3、T4、T8时间点的VAS评分分别为(5.20±0.82)分、(3.90±0.77)分、(3.58±0.76)分、(2.62±0.69)分、(1.98±0.48)分，均低于对照组的(6.03±1.07)、(4.95±0.81)分、(4.03±0.83)分、(3.05±0.76)分、(2.55±0.50)分(均P＜0.05)。治疗后相同时间点治疗组的PSQI较对照组明显降低，差异有统计学意义(均P＜0.05)。治疗组治疗有效率为77.5%(31/40)，优于对照组的50.0%(20/40)，差异有统计学意义(P＜0.05)。结论超声引导下椎旁神经阻滞联合利多卡因凝胶贴膏可以有效缓解带状疱疹后神经痛，改善患者睡眠质量，安全性较好。
- 超声引导 /
- 椎旁神经阻滞 /
- 利多卡因凝胶贴膏 /
- 带状疱疹后神经痛
Abstract: Objective To analyze the clinical efficacy and safety of ultrasound-guided paravertebral nerve block combined with lidocaine gel plaster in the treatment of chest and back postherpetic neuralgia. Methods A total of 80 patients with thoracolumbar post-herpetic neuralgia admitted to the Department of Pain, the First Affiliated Hospital of Bengbu Medical College from October 2020 to December 2021 were randomly divided into control group and treatment group according to the random number table method, with 40 patients in each group. The control group was treated with ultrasound-guided paravertebral block, and the treatment group was treated with ultrasound-guided paravertebral block combined with lidocaine gel plaster. The visual analog scale (VAS) score and Pittsburgh sleep quality index (PSQI), the dosage of pregabalin and the incidence of adverse reactions were compared between the two groups before treatment (T0), 1 week after treatment (T1), 2 weeks after treatment (T2), 3 weeks after treatment (T3), 4 weeks after treatment (T4) and 8 weeks after treatment (T8). Results The VAS scores of treatment groups at T1, T2, T3, T4 and T8 were (5.20±0.82) points, (3.90±0.77) points, (3.58±0.76) points, (2.62±0.69) points, (1.98±0.48) points respectively, which were lower than those in the control group [(6.03±1.07) points, (4.95±0.81) points, (4.03±0.83) points, (3.05±0.76) points and (2.55±0.50) points, all P < 0.05]. The PSQI of the treatment group was significantly lower than that of the control group at the same time point, and the difference was statistically significant (all P < 0.05). The effective rate of the treatment group was 77.5% (31/40), better than that of the control group [50.0% (20/40)], and the difference was statistically significant (P < 0.05). Conclusion Ultrasound-guided paravertebral nerve block combined with lidocaine gel patch can effectively relieve postherpetic neuralgia and improve sleep quality of patients with good safety.
- Ultrasound-guidance /
- Paravertebral nerve block /
- Lidocaine plaster /
- Postherpetic neuralgia

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图 1 超声引导下椎旁神经阻滞

注：A为给药前；B为给药后。

Figure 1. Ultrasound-guided paravertebral nerve block

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表 1 2组PHN患者一般资料比较

Table 1. Comparison of general data of PHN patients between the two groups

组别	例数	性别 (男/女，例)	年龄 (x±s, 岁)	体重 (x±s, kg)	治疗前VAS评分 (x±s, 分)
对照组	40	17/23	64.9±14.2	62.5±12.7	7.55±1.13
治疗组	40	19/21	68.8±9.3	58.4±9.8	7.48±1.08
统计量		0.202^a	1.453^b	1.617^b	0.283^b
P值		0.653	0.150	0.110	0.778
注：^a为χ²值, ^b为t值。

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表 2 2组PHN患者治疗前后VAS评分比较(x±s)

Table 2. Comparison of VAS scores before and after treatment in PHN patients of the two groups(x±s)

组别	例数	T0	T1	T2	T3	T4	T8
对照组	40	7.55±1.13	6.03±1.07^a	4.95±0.81^ab	4.03±0.83^abc	3.05±0.76^abcd	2.55±0.50^abcde
治疗组	40	7.48±1.08	5.20±0.82^a	3.90±0.77^ab	3.58±0.76^ab	2.62±0.69^abcd	1.98±0.48^abcde
t值		0.283	3.894	5.942	2.529	2.649	5.201
P值		0.778	＜0.001	＜0.001	0.013	0.009	＜0.001
注：与同组T0比较，^aP＜0.05；与同组T1比较，^bP＜0.05；与同组T2比较，^cP＜0.05；与同组T3比较，^dP＜0.05；与同组T4比较，^eP＜0.05。

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表 3 2组PHN患者治疗前后PSQI评分比较(x±s，分)

Table 3. Comparison of PSQI scores before and after treatment in the two groups of PHN patients(x±s, points)

组别	例数	T0	T1	T2	T3	T4	T8
对照组	40	16.9±2.53	14.8±2.01^a	11.6±1.84^ab	10.3±1.70^abc	8.5±1.50^abcd	5.5±1.15^abcde
治疗组	40	16.8±2.20	13.7±1.96^a	10.7±1.43^ab	9.5±1.35^abc	5.8±1.16^abcd	3.7±1.24^abcde
t值		0.189	2.478	2.442	2.331	9.006	6.732
P值		0.063	0.015	0.017	0.022	＜0.001	＜0.001
注：与同组T0比较，^aP＜0.05；与同组T1比较，^bP＜0.05；与同组T2比较，^cP＜0.05；与同组T3比较，^dP＜0.05；与同组T4比较，^eP＜0.05。

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表 4 2组PHN患者普瑞巴林使用剂量比较(x±s，mg)

Table 4. Comparison of doses of pregabalin used in PHN patients between the two groups(x±s, mg)

组别	例数	T1	T2	T3	T4	T8
对照组	40	375.0±104.6	309.3±78.1^a	264.3±67.9^ab	211.8±58.5^abc	150.0±58.8^abcd
治疗组	40	313.1±97.4	270.0±86.2^a	223.1±68.9^ab	183.7±53.5^abc	120.6±54.5^abcd
t值		2.739	2.137	2.694	2.242	2.319
P值		0.008	0.036	0.009	0.028	0.023
注：与同组T1比较，^aP＜0.05；与同组T2比较，^bP＜0.05；与同组T3比较，^cP＜0.05；与同组T4比较，^dP＜0.05。

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表 5 2组PHN患者不良反应发生率比较[例(%)]

Table 5. Comparison of incidence of adverse reactions in PHN patients between the two groups [cases (%)]

组别	例数	头晕	嗜睡	胃肠道反应	皮肤反应	局麻药中毒	合计
对照组	40	3(7.5)	5(12.5)	0	0	0	8(20.0)
治疗组	40	1(2.5)	0	0	1(2.5)	0	2(5.0)

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