椎旁神经阻滞联合经皮耳迷走神经电刺激对急性期带状疱疹病人疼痛及情绪的影响  

Effect of paraspinal nerve block combined with transcutaneous auricular vagus nerve stimulation on pain and mood in patients with acute herpes zoster

作　　者：刘倩含 张宇清 杨森 李孝强 陈立平 申文 LIU Qianhan;ZHANG Yuqing;YANG Sen;LI Xiaoqiang;CHEN Liping;SHEN Wen(Department of Pain Management,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]徐州医科大学附属医院疼痛科,徐州221002

出　　处：《中国疼痛医学杂志》2023年第6期429-435,共7页Chinese Journal of Pain Medicine

基　　金：徐州市2022年推动科技创新专项资金资助项目:重点研发计划(社会面发展)-医药卫生面上项目(KC22235)。

摘　　要：目的:观察椎旁神经阻滞联合经皮耳迷走神经电刺激(transcutaneous auricular vagus nerve stimulation,taVNS)对急性期带状疱疹(acute herpes zoster,AHZ)病人的疼痛及情绪的影响。方法:选择我科AHZ病人62例,按随机数字表法分为对照组(S组)和治疗组(T组),每组31例。T组在左耳耳甲处给予taVNS,联合椎旁神经阻滞治疗;S组在左耳耳甲处给予假经皮耳迷走神经电刺激,联合椎旁神经阻滞治疗。观察两组病人治疗前、出院后1周、4周、12周的疼痛数字分级评分法(numerical rating scale,NRS)评分,治疗前、出院后4周、12周的睡眠状况自评量表(self-rating scale of sleep,SRSS)评分,治疗前、出院后1周、4周的简化麦吉尔疼痛问卷(short-form McGill pain questionnaire,SF-MPQ)中的疼痛分级指数(pain rating index,PRI)和现时疼痛指数(present pain intensity,PPI)及状态焦虑量表评分(state-anxiety inventory,S-AI),住院期间盐酸羟考酮片使用例数与曲马多的日平均使用量,病人发展为带状疱疹后神经痛(postherpetic neuralgia,PHN)的例数。结果:随访过程中部分病人脱落,最终58例完成研究,S组28例,T组30例。与治疗前相比,两组病人在治疗出院后1周、4周、12周的NRS评分,出院后4周、12周的SRSS评分以及治疗出院后1周、4周的PRI和PPI及S-AI评分均有所改善(P<0.05);与S组相比,T组在出院后1周、4周的NRS评分和以上各时间点的SRSS、SF-MPQ和S-AI评分,均显著降低;住院治疗期间,T组平均每日曲马多使用量较S组明显降低(P<0.05);T组病人住院期间的盐酸羟考酮片的使用例数及后期发展为PHN的例数显著低于S组(P<0.05)。结论:AHZ病人早期行经皮耳迷走神经电刺激联合椎旁神经阻滞,可以更有效地缓解疼痛、改善病人睡眠、缓解病人焦虑状态及不良情绪、减少镇痛药物的使用,同时可以降低PHN发生率。Objective:To observe the effect of paraspinal nerve block combined with transcutaneous auricular vagus nerve stimulation(taVNS)on pain and mood in patients with acute herpes zoster(AHZ).Methods:Sixty-two patients with AHZ were randomly divided into two groups:the control group(group S)and the treatment group(group T),with 31 patients in each group.Group T was treated with taVNS combined with paraspinal nerve block,while group S was treated with sham taVNS combined with paraspinal nerve block.Numerical rating scale(NRS)scores were observed at admission,1 week,4 weeks and 12 weeks after discharge.Self-rating scale of sleep(SRSS)scores were obserued at admission,4 weeks and 12 weeks after discharge.Pain rating index(PRI)and present pain intensity(PPI)of the simplified short-form McGill pain questionnaire(SF-MPQ)and state-anxiety inventory(S-AI)scores were measured at admission,1 week and 4 weeks after discharge.The number of cases of oxycodone hydrochloride tablets and the average daily use of tramadol during hospitalization,and the number of patients who developed postherpetic neuralgia(PHN)were recorded.Results:During the follow-up,some patients fell off,and 58 cases completed the study,including 28 cases in group S and 30 cases in group T.Compared with those before treatment,the NRS scores at 1,4 and 12 weeks after discharge,the SRSS scores at 4 and 12 weeks after discharge,and the PRI and PPI of the SF-MPQ,and S-AI scores at 1 and 4 weeks after discharge in both groups were improved.Compared with group S,the NRS scores and SRSS,SF-MPQ and S-AI scores of group T were significantly lower at 1 and 4 weeks after discharge.During hospitalization,the average daily use of tramadol in group T was significantly lower than that in group S.The number of cases of oxycodone hydrochloride tablets during hospitalization and the number of patients who eventually developed to PHN in group T were significantly lower than those in group S(P<0.05).Conclusion:Early taVNS combined with paraspinal nerve block in patients with acute he

关 键 词：经皮耳迷走神经电刺激 急性期带状疱疹 焦虑 睡眠 

分 类 号：R614[医药卫生—麻醉学]