竖脊肌平面阻滞联合胸神经阻滞治疗胸背部带状疱疹后神经痛的疗效观察  

Therapeutic effect observation of erector spinae plane block combined with pectoralis nerves block in the treatment of postherpetic neuralgia

作　　者：霍岩松[1] 孙海燕[1] 郭向飞[1] 冉广原 刘亚静 王晟 Huo Yansong;Sun Haiyan;Guo Xiangfei;Ran Guangyuan;Liu Yajing;Wang Sheng(Department of Pain Management,Beijing Anzhen Hospital,Capital Medical Unniversity,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院疼痛科,100029

出　　处：《北京医学》2024年第8期658-661,共4页Beijing Medical Journal

摘　　要：目的探讨竖脊肌平面阻滞(erector spinae plane block,ESPB)联合胸神经阻滞(pectoralis nerves block,PECS)治疗带状疱疹后神经痛(postherpetic neuralgia,PHN)的疗效及安全性。方法选取2022年8月至2023年7月在首都医科大学附属北京安贞医院疼痛科治疗的78例PHN患者,其中男18例、女60例,年龄45~83岁,平均(64±19)岁。38例采用胸椎旁神经阻滞联合皮损区局部神经阻滞(对照组),男11例、女27例,体质量(68.5±8.2)kg,病程5(3,11.8)个月,合并糖尿病8例(21.1%);40例采用ESPB+PECS(观察组),男7例、女33例,体质量(65.7±4.3)kg,病程4.5(3,10.5)个月,合并糖尿病7例(17.5%)。采用视觉模拟评分(visual analogue scale,VAS)及抑郁自评量表(self-rating depression scale,SDS)评估治疗前和治疗后4周时患者的疼痛程度及情绪状态。结果观察组治疗4周后,VAS评分较治疗前显著降低[1(1,2)比7.5(7,8),P<0.001],SDS评分较治疗前显著降低[53(53,53)比55(53,57),P<0.001]。观察组治疗后VAS评分与扩散节段呈负相关(r=-0.3416,P=0.031)。对照组局部出血23例(60.5%),血气胸4例(10.5%);观察组局部出血3例(7.5%),无血气胸病例,两组比较差异有统计学意义(P<0.05)。结论ESPB联合PECS治疗PHN安全性较高、治疗效果显著、操作简便,值得临床推广。Objective To investigate the efficacy and safety of erector spinae plane block(ESPB)combined with pectoralis nerves block(PECS)in the treatment of postherpetic neuralgia(PHN).Methods Seventy-eight patients with PHN treated in the Department of Pain Management,Beijing Anzhen Hospital,Capital Medical University from August 2022 to July 2023 were enrolled.There were 18 males and 60 females,aged from 45 to 83 years,with an average of(64±19)years.Thirty-eight patients were treated by thoracic paravertebral nerve block combined with local nerve block in the lesion area(control group),including 11 males and 27 females,whose median course of disease was 5(3,11.8)months.Forty patients were treated by ESPB combined with PECS(observation group),including seven males and 33 females,whose median course of disease was 4.5(3,10.5)months.The visual analogue scale(VAS)and self-rating depression scale(SDS)were used to assess the pain intensity before and four weeks after treatment.Results After four weeks of treatment,the VAS and SDS scores were significantly lower than those before treatment[VAS:1(1,2)vs.7.5(7,8),P<0.001;SDS:53(53,53)vs.55(53,57),P<0.001].And the VAS score was negatively correlated with the spread segment after combined treatment(r=-0.3416,P=0.031).The incidence of pneumothorax(0 case vs.four cases)and local bleeding(three cases vs.23 cases)of observation group was significantly lower than those of the control group(P<0.05).Conclusions ESPB combined with PECS for the treatment of PHN is a safe,effective,and easy-to-operate method.

关 键 词：竖脊肌平面阻滞 胸神经阻滞 带状疱疹后神经痛 胸椎旁神经阻滞 

分 类 号：R752.12[医药卫生—皮肤病学与性病学]