超声引导后路肋间神经阻滞对带状疱疹性神经痛患者的疗效  

Ultrasound-guided posterior approach to intercostal block for herpetic neuralgia

作　　者：林海[1] 王权光[1] 张慧玲[1] 刘乐[1] 皮治兵[1] 徐旭仲[1] 

机构地区：[1]温州医学院附属第一医院麻醉科,325000

出　　处：《中华麻醉学杂志》2011年第1期47-49,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价超声引导后路肋间神经阻滞对带状疱疹性神经痛患者的疗效.方法 拟行后路肋间神经阻滞的胸背部带状疱疹性神经痛患者48例,性别不限,年龄56～84岁,体重48～83 kg病程＜30 d.后路肋间神经阻滞用药：0.75%罗哌卡因10ml＋确炎舒松A 20 mg＋2%亚甲蓝2ml,用0.9%生理盐水配制成20ml.采用便携超声仪和高频直线探头（6～13 MHz）或腹部扇形探头（2～5 MHz）,采用超声引导长轴平面内技术,穿刺针尖到达胸膜外,近肋骨下阴影区域时,回吸注射器无回血后,根据带状疱疹分布阻滞肋间神经,每束肋间神经注射镇痛药3ml.于治疗前、治疗后1、2、4和8周采用VAS评分法评价疼痛程度,计算疼痛缓解度,采用生活质量评分法评价生活质量;于治疗后8周进行镇痛疗效分级,计算治疗有效率和显效率,记录并发症的发生情况.结果 操作过程中均未发生穿刺针误穿胸膜,阻滞后患者均未发生胸闷或呼吸困难.治疗后各时点VAS评分降低,生活质量升高,疼痛缓解度逐渐升高（P＜0.05或0.01）.治疗后8周有效率96%,显效率83%.结论 超声引导后路肋间神经阻滞对带状疱疹性神经痛患者的疗效确切,不良反应少,改善了生活质量.Objective To evaluate ultrasound-guided posterior approach to intercostal block for herpetic neuralgia. Methods Forty-eight patients with herpetic neuralgia after appearance of rashes on the back of chest （the coursc 〈 30 days） aged 56-84 yr received intercostal block performed via posterior approach under the guidance of ultrasound with a mixture of 0.75% ropivacaine, glucocorticoid and methylene blue. Pain was assessed with visual analogue scale （VAS） before block and at 1, 2, 4 and 8 weeks after block. Pain relief （PAR） was cal-culated （PAR= （VAS score before block- VAS score after block） ÷ VAS score before block × 100%）. Results No patient developed dyspnea and pneumothorax. VAS scores were reduced significantly, quality of life was improved and PAR increased at 1, 2, 4 ancl 8 weeks after block （ P 〈 0.05 or 0.01）. Concluslon Ultracound-guided posterior approach to intercostal block is safe and effective for the treatment of herpetic neuralgia.

关 键 词：神经传导阻滞 肋间神经 超声检查 疱疹 带状 神经痛 

分 类 号：R614[医药卫生—麻醉学]