加味散血葛根汤联合神经阻滞对带状疱疹后遗神经痛血脉瘀阻证患者的临床疗效  

Clinical Efficacy of Modified Sanxue Gegentang Combined with Nerve Block on Postherpetic Neuralgia Due to Blood Stasis Syndrome

作　　者：屠远辉[1] 方玉甫[1] 王丽[1] TU Yuan-hui;FANG Yu-fu;WANG Li(Henan Province Hospital of Traditional Chinese Medicine,Zhengzhou 450002,China)

机构地区：[1]河南省中医院,郑州450002

出　　处：《中国实验方剂学杂志》2020年第21期129-134,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河南省中医药研究专项(2018ZY020372)。

摘　　要：目的:观察加味散血葛根汤联合神经阻滞治疗带状疱疹后遗神经痛血脉瘀阻证的临床疗效,探讨其机制。方法:120例患者随机分为对照组和观察组,各60例。对照组给予大黄蛰虫片+神经阻滞,观察组给予加味散血葛根汤+神经阻滞,疗程均为4周。观察两组治疗前后临床症状(简化McGill疼痛量表、总体印象变化量表、中医证状),血清疼痛介质[内皮素-1(ET-1),前列腺素E2(PGE2),P物质(SP),环氧化酶-2(COX-2)],血黏度指标[全血高切黏度(HBV),全血中切黏度(MBV),全血低切黏度(LBV),血浆黏度(PV)]。比较两组临床疗效,随访12个月复发率及不良反应发生率。结果:研究过程中对照组脱落5例,观察组脱落1例。观察组总有效率96.6%(57/59),高于对照组的74.5%(41/55()χ2=5.729,P<0.05)。与对照组治疗后比较,观察组简化McGill疼痛量表,总体印象变化量表,中医症状,疼痛介质(ET-1,PGE2,SP,COX-2),血黏度(HBV,MBV,LBV,PV)明显降低(P<0.05)。随访12个月,观察组(显效+有效)复发率7.0%(4/57),低于对照组的43.9%(18/41)(χ2=7.294,P<0.05)。研究期间观察组不良反应发生率为8.5%(5/59),对照组为7.3%(4/55),两组比较差异无统计学意义。结论:加味散血葛根汤联合神经阻滞可明显改善带状疱疹后遗神经痛血脉瘀阻证患者的临床症状,复发率和不良反应发生率低。Objective: To observe the efficacy of modified Sanxue Gegentang combined with nerve block in treating postherpetic neuralgia due to blood stasis syndrome,and explore its possible mechanism.Method: The 120 patients were randomly divided into control group and observation group,with 60 cases in each group. The patients in control group received Dahuang Zhechong tablet + nerve block,and the patients in observation group received modified Sanxue Gegentang + nerve block for 4 weeks. The clinical symptoms(simplified McGill pain scale,overall impression change scale,traditional Chinese medicine symptoms),serum medium pain [endothelin-1(ET-1),prostaglandin E2(PGE2),substance P(SP),cydooxygenase-2(COX-2)],blood viscosity index[high blood viscosity(HBV),medium blood viscosity(MBV),low blood viscosity(LBV),and plasma viscosity(PV)]were observed before and after treatment. The clinical efficacy,recurrence rate in 12 months follow-up,and the incidence of adverse reactions were compared between two groups. Result:The 5 cases in control group and 1 case in the observation group were lost during the study. The total effective rate in observation group was 96.6%(57/59),higher than 74.5%(41/55)in control group(χ2=5.729,P<0.05). As compared with control group after treatment,the McGill pain scale,overall impression change rating scale,main TCM symptom scores,pain medium(ET-1,PGE2,SP,COX-2),and blood viscosity(HBV,MBV,LBV,PV)were significantly lower in observation group(P<0.05). In the follow-up for 12 months,the recurrence rate was 7.0%(4/57)in observation group,lower than 43.9%(18/41)in control group(χ2=7.294,P<0.05). During the study period,the incidence of adverse reactions was 8.5%(5/59)in observation group and 7.3%(4/55)in control group, without significant difference between two groups.Conclusion: Modified Sanxue Gegentang combined with nerve block can significantly improve the clinical symptoms of patients with postherpetic neuralgia due to blood stasis syndrome,showing a low recurrence rate incidence of adverse reactions.

关 键 词：加味散血葛根汤 神经阻滞 血脉瘀阻证 带状疱疹后遗神经痛 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学]