早期夹脊穴注射丹参注射液预防带状疱疹后遗痛的疗效分析  

Effect of early injection of salvia miltiorrhiza in Jiaji Points on the incidence of post-herpetic neuralgia

作　　者：王海滨 沈亮[2] 李浪平[2] 陆志俊[3] 陈蕾[3] WANG Haibin;SHEN Liang;LI Langping;LU Zhijun;CHEN Lei(Department of Anaesthesiology,Ruijin Hospital North Branch,Shanghai Jiao Tong University School of Medicine,Shanghai 201800,China)

机构地区：[1]上海交通大学医学院附属瑞金医院北院麻醉科,上海201800 [2]上海交通大学医学院附属瑞金医院卢湾分院麻醉科,上海201800 [3]上海交通大学医学院附属瑞金医院麻醉科,上海201800

出　　处：《上海医学》2019年第11期657-661,共5页Shanghai Medical Journal

基　　金：上海市卫生和计划生育委员会中医药专项课题资助(2016LP008).

摘　　要：目的评价早期夹脊穴注射丹参注射液预防带状疱疹患者后遗痛(PHN)的有效性。方法选择104例急性带状疱疹患者,随机分为两组,每组52例,分别在治疗组和对照组的疱疹皮损与疼痛区域相应的夹脊穴位注射丹参注射液或0.9%氯化钠溶液。所有患者口服泛昔洛韦片300 mg,2次/d,持续7 d。口服加巴喷丁第1天300 mg,可逐日递增至1800 mg/d,分3次服用,当疼痛VAS评分≤3分时,药物开始减量;必要时给予口服曲马多缓释片50~100 mg,每12 h 1次。记录治疗前和治疗后1周、3周、6周、3个月、6个月的疼痛VAS评分和每周口服药物的总量;记录治疗后3和6个月的PHN发生率;检测患者治疗前和治疗后3个月外周血中β-内啡肽水平。结果两组患者在治疗后1周、3周、6周、3个月、6个月的疼痛VAS评分均显著低于同组治疗前,治疗组治疗后各时间点的疼痛VAS评分均显著低于对照组同时间点(P值均<0.01);治疗组治疗后3、6个月的PHN发生率显著低于对照组(P值均<0.05)。治疗组患者在治疗期间每周口服的加巴喷丁和奇曼丁缓释片剂量均显著低于对照组(P值均<0.01)。治疗后3个月两组患者血浆β-内啡肽水平均显著高于治疗前(P值均<0.01),治疗组血浆β-内啡肽水平显著高于对照组(P<0.01)。结论夹脊穴注射丹参注射液能有效减轻急性带状疱疹性患者的疼痛,降低PHN发生率,是预防PHN的一种可行性方法。Objective To evaluate the effectiveness of early injection of salvia miltiorrhiza in the Jiaji Points on the incidence of post-herpetic neuralgia(PHN).Methods A total of 104 patients with acute herpes zoster were randomly divided into two groups(n=52).Normal saline(control group)and salvia miltiorrhiza(treatment group)were injected into the Jiaji Points of skin lesion and pain regions,respectively.Famciclovir(300 mg)was given orally in all the patients 2 times per day for 7 days.The dose of gabapentin was 300 mg on the first day(3 times a day),and gradually increased to the maximum dose of 1800 mg/d.Tramadol(50-100 mg,every 12 hours)was provided when necessary.Visual analog scale(VAS)and total amount of analgesics were recorded at the initial visit(basal),the 1 st,3 rd,6 th week after injection,3 and 6 months after rash onset.The incidence of PHN was recorded at 3 and 6 months after onset.β-endorphin in the peripheral blood was detected at 3 months after onset.Results VAS score was decreased in all the patients at each time point after treatment(all P<0.01).Moreover,VAS score in the treatment group was significantly lower than that in the control group after treatment(all P<0.01).The incidence of PHN in the treatment group was significantly lower than that in the control group at 3 and 6 months after treatment(both P<0.05).There was a significant reduction in the dose of gabapentin and tramadol(both P<0.01)and a significant increase inβ-endorphin in treatment group in comparison to control group(P<0.01).Conclusion The injection of salvia miltiorrhiza in the Jiaji Points is effective in reducing the pain in patients with acute herpes zoster and the incidence of PHN.It may be a feasible method to prevent PHN.

关 键 词：丹参 神经痛 带状疱疹后 夹脊穴 急性带状疱疹 预防 

分 类 号：R275.9[医药卫生—中西医结合]