连续硬膜外阻滞联合口服镇痛药物治疗下肢带状疱疹亚急性期疼痛患者的疗效  

Effects of continuous epidural block combined with oral analgesics for the treatment of patients with herpes zoster related pain in the lower limb during subacute period

作　　者：李少军 冯丹[1] 张书力[1] 胡焓[1] 乔杰[1] 袁峰[1] Li Shaojun;Feng Dan;Zhang Shuli;Hu Han;Qiao Jie;Yuan Feng(Department of Pain Management,Wuhan First Hospital,Wuhan City 430022,China)

机构地区：[1]武汉市第一医院疼痛科,430022

出　　处：《实用疼痛学杂志》2018年第6期429-438,共10页Pain Clinic Journal

摘　　要：目的 观察连续硬膜外阻滞联合口服镇痛药物治疗下肢带状疱疹亚急性期疼痛的疗效及安全性.方法 分析2015年12月至2017年12月在武汉市第一医院疼痛科就诊的下肢带状疱疹后疼痛患者(疼痛持续超过1个月)73例的临床资料.将所纳入研究的疱疹亚急性期疼痛患者随机分为两组,连续硬膜外组(n=38)和口服药物组(n=35).连续硬膜外组采用2%利多卡因70 ml,用0.9%生理盐水稀释至180 ml,以3 ml/h速率连续硬膜外阻滞治疗5d,配合口服药物加巴喷丁胶囊,600 mg/次,3次/d;盐酸曲马多缓释片0.1g,每12小时1次.口服药物组与上述口服药物相同.采用Izbicki疼痛评分系统和焦虑自评量表(SAS)评估治疗前及治疗后7d,治疗后3与6个月时患者疼痛得分和焦虑状况.此外,按疼痛持续时间将连续硬膜外组分为两亚组:亚组1为下肢带状疱疹后疼痛持续在1~3个月,即亚急性期(n=26例);亚组2为下肢带状疱疹后疼痛持续超过3个月,即带状疱疹后神经痛期(PHN)(n=12例).采用欧洲癌症研究与治疗组织生活质量调查问卷(EORTC-QLQ-C30)评分系统评估治疗后6个月时患者的生活质量.结果 连续硬膜外组患者在治疗后7d、3个月及6个月时的疼痛VAS评分,疼痛频率及劳动能力得分均低于口服药物组,差异有统计学意义(P<0.05);在治疗后6个月时,连续硬膜外组患者口服镇痛药物比例及焦虑状况得分均低于口服药物组(P<0.05),但治疗后7d与3个月时两组患者差异无统计学意义(P≥0.05).此外,亚组2患者在连续硬膜外阻滞治疗后6个月时疼痛VAS评分,疼痛频率,口服镇痛药物和失去劳动能力得分均高于亚组1患者,差异有统计学意义(P<0.05);在生活质量方面,亚组2患者的功能指标(躯体功能、角色功能、情绪功能及社交功能)、总体健康得分较低,差异有统计学意义(P<0.05).各症状项目包括疼痛、失眠、食欲情况得分高,差异有统计学意义(P<0.05).结论 连续�Objective To explore the safety and efficacy of continuous epidural block combined with oral analgesics for the treatment of patients with herpes zoster related pain in the lower limb during subacute period.Methods Seventy-three patients with herpes zoster related pain in the lower limb persisted more than 1 month from December 2015 to December 2017 in Wuhan First Hospital were analyzed.The patients were divided into 2 groups randomly:continuous epidural block group (n=38) and oral drug group (n=35).Epidural catheter was connected to continuous analgesic pump contained 70 ml 2% lidocaine diluted to 180 ml with 0.9% normal saline at the infusion rate of 3 ml/h for 5 d,and combined with oral gabapentin capsules,600 mg/time,3 times a day,and tramadol 0.1g,every 12 hours in the continuous epidural block group.Only oral medication was taken in the oral drug group.Izbicki pain score system and self-rating anxiety scale (SAS) were used to assess pain control and anxiety before the treatment,and 7 days,3 months and 6 months after the treatment.According to the time of pain persisting,the continuous epidural block group was classified into two subgroups:subgroup 1(pain persisting between 1 and 3 months,subacute phase,n=26);subgroup 2 (pain persisting more than 3 months,postherpetic neuralgia,n=26).European Organization for Research and Treatment of Cancer (EORTC) was used to evaluate the quality of life at 6 months after the treatment.Results Pain scores (visual analogue scale,frequency of pain attacks,and inability to work) were significantly lower in continuous epidural block group than those in the oral drug group (P<0.05).At 6 months,the analgesics medication used and anxiety scores were lower in continuous epidural block group than those in the oral drug group (P<0.05).No differences were found in analgesic medication used and SAS score at 7 d and 3 months (P≥0.05) between the two groups.However,the dosage of analgesic medication was lower in continuous epidural block than that in oral drug group at 6 months (P<0.0

关 键 词：麻醉 硬膜外 疱疹 带状 下肢 时间因素 

分 类 号：R6[医药卫生—外科学]