阿霉素与庆大霉素外周神经阻滞治疗三叉神经痛的远期疗效比较  

Long-term therapeutic efficacy of peripheral block by adriamycin versus gentamicin on treatment of trigeminal neuralgia

作　　者：申颖[1] 赵宏利[2] 王保国[1] 

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,北京市100050 [2]北京垂杨柳医院麻醉科,北京市100022

出　　处：《中国临床康复》2006年第48期42-44,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:应用阿霉素及庆大霉素外周神经阻滞治疗三叉神经痛,比较两种药物的远期治疗效果和副作用,探讨三叉神经痛治疗的适宜方法。方法:选择2002-12/2003-06于北京天坛医院疼痛中心收治,经卡马西平等药物治疗无效或难以耐受其副作用的三叉神经痛患者70例,区组随机分为2组(n=35):①阿霉素组:将阿霉素粉剂用生理盐水稀释成5g/L的溶液,第Ⅰ支注射部位为眶上孔,第Ⅱ支为眶下孔或上颌神经,第Ⅲ支根据疼痛部位选择颏孔、下牙槽神经或下颌神经阻滞。若疼痛无明显缓解,可于一两周后再次阻滞一次。②庆大霉素组:应用庆大霉素针剂(8万单位/支),阻滞方法同阿霉素组,可阻滞四或五次,1次/周,每次剂量为8万单位。治疗前应用目测类比评分(无痛时为0,最剧烈疼痛时为10)进行疼痛评估,治疗后用电话、信件随访,分别在治疗第6,12,18,24,30个月记录数字评分(评分方法同目测类比评分),同时记录治疗后镇痛有效率(≥2度,即疼痛减轻1/2及以上)以及并发症的发生率、持续时间和程度。结果:70例全部进入结果分析。①镇痛的有效率:两组患者在治疗后6个月时相似,但在第12,18,24,30个月阿霉素组明显高于庆大霉素组(68%,57%,28%,23%;31%,20%,6%,6%,P<0.05)。②疼痛强度变化:阿霉素组在治疗后两年半内数字评分均低于治疗前(P<0.01),庆大霉素组仅在治疗后6,12个月时低于治疗前(4.3±1.5,5.5±1.7,7.9±1.6,P<0.01),至1年后疼痛强度与治疗前无差异(P>0.05),且数字评分高于相应时间点的阿霉素组评分。③并发症的比较:阿霉素组面部麻木和肿胀的发生率高于庆大霉素组(91%比17%;91%比28%,P<0.01);持续的时间和长于庆大霉素组[(122±31),(7±2)d;(66±13),(5±2)d,P<0.01];程度重于庆大霉素组。结论:阿霉素外周神经阻滞对三叉神经痛的远期镇痛效果较庆大霉素好,其副作用相对比庆大霉素大,但是操作简单安全。AIM： To compare the long-term therapeutic effects and side effects of peripheral nerve block with adriamycin （ADM） and gentamicin （GM） on trigeminal neuralgia, and explore the better method to treat trigeminal neuralgia. METHODS： Seventy patients with trigeminal neuralgia, who had not recovered after treatment with carbamazepine and other medicine or were not tolerant to the side effects, admitted to the Department of Anesthesiology and Pain Center, Beijing Tiantan Hospital from December 2002 to June 2003 were selected and randomly divided into 2 groups with 35 cases in each group： ①ADM group： The ADM power were diluted to 5 g/L solution with normal saline and were firstly injected into supraorbital foramen, secondly infraorbital foramen or maxillary nerve, and thirdly anterior maxillary foramen, dental nerve or mandibular nerve block, respectively. The injection was conducted once more 1 or 2 weeks later, if the pain was not released. ②GM group： GM （8×10^4 U each） was injected into the patients with the same block method for four or five times, once per week with 8 ×10^4 U each time, The patients were measured and recorded pain intensity with visual analogue scale （VAS, 0 meant painless, 10 meant the maximum pain） before treatment, and numeric rating scales （NRS） was used at 6, 12, 18, 24 and 30 months during follow-up by telephone or correspondence after treatment. Meanwhile, the pain relief rate （≥ 2 degrees meant the pain was released more than 1/2）, occurrence rate of complication, duration and degree were assessed after treatment. RESULTS： All the 70 cases were involved in the result analysis. ① Effective rate： The pain relief state of the patients in the two groups were similar at 6 month after treatment, but at post-treatment 12, 18, 24, 30 months, the ADM group were significantly higher than that in the GM group （68%, 57%, 28%, 23%; 31%, 20%, 6%, 6%, P 〈 0.05）. ②The changes of pain intensity： The NRS of the ADM group in two years and a half after

关 键 词：三叉神经痛 多柔比星 庆大霉素类 神经传导阻滞 

分 类 号：R745.11[医药卫生—神经病学与精神病学]