静脉输注利多卡因对椎旁神经阻滞治疗亚急性期带状疱疹性神经痛疗效的影响  

Effects of intravenous infusion lidocaine on paravertebral nerve block for the treatment of patients with subacute herpetic neuralgia

作　　者：刘云琴 高鸿 贺纯静[3] 康新国[3] Liu Yunqin;Gao Hong;He Chunjing;Kang Xinguo(Graduate School,Guizhou Medical University,Guiyang City,Guizhou Province 550004,China;Department of Anesthesiology,The Affiliated Hospital of Guizhou Medical University,Guiyang City,Guizhou Province 550004,China;Department of Painology,Guizhou Provincial People's Hospital,Guiyang City,Guizhou Province 550002,China)

机构地区：[1]贵州医科大学研究生院,贵阳市550004 [2]贵州医科大学附属医院麻醉科,贵阳市550004 [3]贵州省人民医院疼痛科,贵阳市550002

出　　处：《中华疼痛学杂志》2023年第2期273-279,共7页Chinese Journal Of Painology

摘　　要：目的:评价静脉输注利多卡因对椎旁神经阻滞治疗亚急性期带状疱疹性神经痛(SHN)疗效的影响。方法:收集2020年11月至2021年11月在贵州省人民医院疼痛科住院并确诊为胸腰段SHN患者80例,年龄45~75岁,性别不限,持续疼痛1~3个月,视觉模拟评分(VAS)≥4分,按照随机数据表法将其分为椎旁神经阻滞治疗组(N组)和利多卡因输注联合椎旁神经阻滞治疗组(L组),各组40例。两组均常规给予药物(甲钴胺片+普瑞巴林胶囊)治疗,同时两组患者每日均在B超引导下行椎旁神经阻滞治疗1次,根据皮损及疼痛部位确定阻滞的椎旁脊神经根,在B超引导下将神经阻滞液(2%盐酸利多卡因注射液2 ml+地塞米松磷酸钠注射液2.5 mg+维生素B_(12)注射液0.5 mg+0.9%氯化钠注射液,共5 ml)注射至椎旁间隙,其中L组在药物及神经阻滞治疗的基础上,每日给予利多卡因(3 mg/kg)静脉输注治疗,输注速率为25 ml/h,连续5 d,记录两组患者治疗前(T0)及治疗后1、3、5、30、60、90 d(T1~T6)的VAS评分、睡眠状况自评量表评分(SRSS)、局部皮温、镇痛药物使用剂量及治疗期间不良反应发生情况。 结果:两组患者T3~T6时VAS评分、SRSS评分及镇痛药物使用量较治疗前均降低( P均<0.05);与N组比较,L组治疗T3~T6的VAS评分、SRSS评分及镇痛药物使用量均较低( P均<0.05);与T0患侧相比,T3时两组患者患侧皮温均降低,( P均<0.05);T3时,L组患侧皮温较N组降低更明显,差异有统计学意义( P<0.05);与N组比较,L组PHN发生率较低( P<0.05);两组患者均未见严重并发症发生。 结论:静脉输注利多卡因可优化椎旁神经阻滞治疗SHN的疗效,减少镇痛药物使用量并降低PHN的发生率。Objective To explore the effects of lidocaine intravenous infusion on paravertebral nerve block for the treatment of patients with subacute herpetic neuralgia(SHN).Methods From November 2020 to November 2021,80 patients with thoracolumbar SHN hospitalized,aged 45-75 years old,gender not limited,persistent pain for 1 to 3 months,visual analogue scale(VAS)≥4,in the Department of Painology,Guizhou Provincial People's Hospital were collected.According to the random data table,all patients were divided into paravertebral nerve block group(group N)and lidocaine combined with paravertebral nerve block group(group L),40 cases in each group.All patients were routinely treated with medication(methobalamin tablet+pregabalin capsule)in both groups.The patients received paravertebral nerve block,once a day,under the guidance of ultrasound in both groups.The nerve block solution(2%lidocaine hydrochloride injection 2 ml+dexamethasone sodium phosphate injection 2.5 mg+vitamin B_(12) injection 0.5 mg+0.9%sodium chloride injection add up to 5 ml)was injected into the paravertebral space under the guidance of ultrasound.In group L,intravenous infusion of lidocaine(3 mg/kg)was added,with infusion rate 25 ml/h,daily for 5 consecutive days.VAS was recorded before the treatment(T0)and at 1,3,5,30,60 and 90 d(T1-T6)after the treatment.VAS,self-rating scale of sleep(SRSS),local skin temperature,dose of analgesic drugs,and the occurrence of adverse reactions were recorded.Results VAS,SRSS and the dosage of analgesics were decreased at T3-T6 compared with pre-treatment(all P<0.05).Compared with the group N,VAS,SRSS and the dosage of analgesics at T3-T6 were significantly decreased in group L(all P<0.05).Compared with T0,the skin temperature was decreased at T3 in two groups(all P<0.05).Compared with the group N,the skin temperature was decreased in group L at T3(all P<0.05).The incidence of PHN was significantly lower in the group L than that in the group N(P<0.05).No serious complications occurred in both groups.Conclusion Intravenous i

关 键 词：利多卡因 输注 静脉内 神经传导阻滞 亚急性期带状疱疹性神经痛 

分 类 号：R752.12[医药卫生—皮肤病学与性病学]