牛痘疫苗接种家兔炎症皮肤提取物及连续星状神经节注药治疗头面部疱疹后神经痛临床研究  

CONTINUOUS SGB WITH NEUROTIN FOR TREATMENT OF TRIGEMINAL POST-HERPETIC NEURALGIA

作　　者：王家双[1] 魏星[1] 包佳巾[1] 杜雯琼[1] 汤达承[1] 吴秋韵 

机构地区：[1]中华医学会疼痛学会临床培训医院,暨南大学广州红十字会医院疼痛科,广州510220

出　　处：《中国疼痛医学杂志》2015年第3期194-196,共3页Chinese Journal of Pain Medicine

基　　金：科技部“12-5”计划课题;国家科技支撑项目(2013BAI04B04)

摘　　要：目的：三叉神经带状疱疹后神经痛是头面部疼痛疾病中最为剧烈的疼痛疾病之一。本文报道使用牛痘疫苗接种家兔炎症皮肤提取物（神经妥乐平）及连续星状神经节注药（CSGB）对比药物治疗三叉神经区疱疹后遗神经痛的临床疗效分析。方法：本组40例患者,病程3个月-4年。使用VAS评分评价疼痛程度;使用改良HAMD评价抑郁程度;同时检查治疗前、后损伤区域红外热图。门诊（OP）组治疗方法：甲钴胺2 mg/日,神经妥乐平2-4片/日,加巴喷丁600-900 mg/日或普瑞巴林150-450 mg/日。住院（IP）组治疗方法：口服药同OP组,CSGB处方：0.1%罗哌卡因200 ml＋神经妥乐平6 ml,连接PCA泵（ZBB-Ⅰ型,南通产）,持续量0.5-1 ml/h,追加剂量0.5 ml/次,持续使用一周。两组患者均于治疗两周及随访一年后评价效果。结果：患者主诉头面部自发性闪电样疼痛、刀割样疼痛、烧灼样疼痛为主。两组患者平均HAMD评分为21.8±3.8分,平均VAS评分为7.8±1.6分。经过治疗后OP组和IP组患者平均VAS评分分别为5.4±1.2：3.2±0.8分,HAMD评分为18.5±3.1：11.2±2.1分;复发率为45%：20%;治疗前、后局部红外热图平均差值为：1.2-5.8℃。IP组经过14-18个月的随访,疗效相对稳定。对于复发患者则采用其他方法进行治疗。结论：两组头面疱疹后神经痛患者初步结果表明：与OP组治疗结果比较,IP组加用CSGB方法安全,有效,能够快速控制剧烈疼痛,患区后遗症状大部分缓解。经过一年左右随访大部分患者效果稳定,生活质量明显改善。Objective： Trigeminal post-herpetic neuralgia is one of the typical painful diseases of head or face area. This study is to explore the clinical effects of continuous SGB with neurotin on trigeminal post-herpetic neuralgia. Methods： Forty patients with trigeminal post-herpetic neuralgia were included in this study. The index of pain types, sleeping condition, and remaining symptoms in zoster area were recorded. VAS and modified HAMD score were used to evaluate the pain and emotion condition. Thermography was selected to monitor local temperature. gabapendine（600-900mg）, neurotin（2-4 tables）, and mecobalam（1.5mg） were orally taken by the patients daily in both groups, i.e., irritable nociceptor group（38 cases）, deafferentation group（22 cases）. Continuous SGB was exerted in IP group. Results： Lightning pain, lancinating pain and burning pain were the main complaint in clinical setting. The average VAS score was 7.8±1.6 and the HAMD score was 21.8±3.8. After treatment, the average VAS score of both group were 5.4±1.2vs3.2±0.8, HAMD score of both group were18.5±3.1vs11.2±2.1, and recurrent rates of both group were 45%vs 20%. The effect was stable after 14-18 months follow up in IP group. There were significantly changes of surface temperature before and after treatment with the examination of thermography, the mean value between 1.2 - 5.8℃. Conclusion： After treatment by continuous SGB with neurotin injection, the quality of life of IP group was markedly improved, the effects of pain-relief or paresthesia of zoster area were much better than those in OP group during 14-18 months followed up.

关 键 词：三叉神经疱疹后神经痛 连续星状神经节注药 神经妥乐平 红外热图 

分 类 号：R752.12[医药卫生—皮肤病学与性病学]