氯胺酮用于椎旁阻滞预防疱疹后神经痛的临床研究  

Clinical research of ketamine unification latero-rhachis nerve block to prevent post-herpetic neuralgia

作　　者：李清[1] 刘菊英[1] 秦成名[1] 胡云[1] 王贤裕[1] 

机构地区：[1]郧阳医学院附属太和医院麻醉科,湖北十堰442000

出　　处：《重庆医学》2008年第17期1916-1918,1921,共4页Chongqing medicine

摘　　要：目的观察急性期带状疱疹患者不同剂量氯胺酮用于椎旁神经阻滞防治疱疹后神经痛的临床疗效。方法选择60例经常规抗病毒和神经营养支持治疗1周后仍有剧烈疼痛的胸腰部带状疱疹急性期患者,随机分为3组(每组20例),行椎旁神经阻滞。椎旁神经阻滞的范围为病变同侧对应脊神经节段及相邻上、下脊神经节段。L组为对照组,1%利多卡因加维生素B120.5mg和曲安奈德5mg混和液;LK1组,L组用药联合0.25mg/kg氯胺酮混合液于各穿刺点分别推注2.5mL;LK2组,L组用药联合0.5mg/kg氯胺酮,各穿刺点分别推注2.5mL。每例患者注药后30min内监测血压、心率、呼吸、脉搏氧饱和度、精神状态等变化。各组患者3d治疗1次,5次为1个疗程,各组于接受治疗前和疗程结束时分别进行VAS评分。在达到皮损痊愈和疼痛有效缓解的治疗效果后,随访10个月,项目包括疼痛疗效、生活质量以及工作能力、患区后遗症状等。结果与L组比较,LK1和LK2组治疗时间短(P<0.05),疗程结束时LK1和LK2组VAS评分均明显降低(P<0.01);治疗过程中各组血压、心率、呼吸、脉搏氧饱和度均无明显变化,LK2组部分患者出现眩晕或精神症状。随访发现L组患者有明显的疱疹后神经痛,发生率为50%,LK1和LK2组患者疱疹后神经痛发生率低(均为5%),与L组比较,P<0.01,且症状轻微,能保持稳定疗效,精神面貌好,生活质量显著改善。结论带状疱疹急性期行椎旁神经阻滞联合亚剂量氯胺酮干预能治愈患者,并可有效防治疱疹后神经痛。Objective To investigate the clincal curative effect of latero-rhachis nerve block unification ketamine intervention at patients herpes zoster acute stage to prevent and cure post-herpetic neuralgia. Methods 60 patients with chest and waist herpes zoster acute stage to lead anti-virus and neurotrophy supportive treatment,yet the therapy inefficacy and no way to suffer the in- tense pain, then treatment with latero-rhachis nerve block unification different dosage ketamine intervention. Locating upper and inferior sites of the corresponding diseased region homonymy nerve segment meanwhile and puncture inject physic liquor to block the nerve root. The sufferers were treated with following three conditions（n=20） ： （1）group-L：control group sham treating with 2.5 mL mixing fluid of 1% lidocaine added 0.5mg VitB12 and 5mg triamcinolone in each site; （2）group-LK1 ：treated with 2.5mL mixing fluid of 1% lidocaine added 0.5rag VitB12 and 5rag triamcinolone and 0.25mg/kg ketamine in each site; （3） group-LK2 ：treated with 2.5mL mixing fluid of 1%lidocaine added 0.5mg VitBt2 and 5rag triamcinolone and 0.5mg/kg ketamine in each site. Within 30min administer, monitoring the changes of blood pressure, heart rate, respiration, pulse 02 saturation, mental status and so on. The patients treated once per trid,per quintic for one course of treatment. The patients of each group conceive VAS score at pretherapy and time of therapy termination. After the damaged skin of herpes region recovery and the pain relieve efficiently, both home telephone inquiry and follow up during out-patient service were carried out in 60 cases for 10 months including therapeutic effect,emotion score,ability of work and remaining symptom of herpes area. Results The time of therapy were short（P〈0.05） and VAS was low in LK1 and LK2 groups（P〈0.01）compared with that in Group L, no marked changes of blood pressure, heart rate, respiration, pulse O2 saturation,but part patients occurrence dizzy or psychiatric symptom in group-LK2

关 键 词：带状疱疹急性期 椎旁神经阻滞 氯胺酮 疱疹后神经痛 

分 类 号：R752.12[医药卫生—皮肤病学与性病学] R614.1[医药卫生—临床医学]