神经阻滞预防带状疱疹后神经痛及其高危因素分析

张细丽; 孟汶; 李倩烨; 王国梁; 李彦林; 张小梅

神经阻滞预防带状疱疹后神经痛及其高危因素分析

1. 昆明医科大学第一附属医院疼痛科
2. 昆明医科大学第一附属医院运动医学科

基金项目:

基金：云南省骨关节疾病诊疗省创新团队基金资助项目 (2014HC1018);

计量
- 文章访问数: 2083
- HTML全文浏览量: 668
- PDF下载量: 88
- 被引次数: 0
出版历程
- 收稿日期: 2017-04-21

Prevention of Postherpetic Neuralgia by Nerve Block and Analysis of Risk Factors

Funds:

基金：云南省骨关节疾病诊疗省创新团队基金资助项目 (2014HC1018);

摘要

摘要: 目的探讨神经阻滞对治疗带状疱疹 (HZ) 和预防带状疱疹后神经痛 (PHN) 的效果, 探寻影响PHN发生的因素.方法 2015年1月至2016年9月昆明医科大学第一附属医院疼痛科收治的首次发病且未经任何治疗的急性期HZ患者80例.随机分配到病例组 (神经阻滞+常规内科治疗) 40例, 和对照组 (常规内科治疗) 40例.对比2组带状疱症后神经痛发生率, 分析年龄、性别、疱疹部位、前驱性疼痛、初始疼痛程度、结痂时间、和治疗1周时的疼痛缓解率等, 与PHN发生率的相关关系.结果病例组有4例 (10.0%) 发生PHN, 较对照组19例 (47.5%) 显著降低 (P<0.001) .病例组住院天数减少 (7.43±1.80) d vs (12.90±2.36) d, P<0.001, 结痂时间缩短 (6.33±0.86) d vs (7.15±0.66) d, P<0.001.高龄 (OR:13.03, 95%CI:2.7362.34) 、发病起始的VAS评分 (OR:8.24, 95%CI:1.6241.96) 和结痂时间延长 (OR:17.99, 95%CI:2.14151.43) , 是PHN的危险因素, 显著增加PHN发生率.治疗1周时的VAS缓解率 (OR<0.000, 95%CI:0.0000.001) , 是PHN的保护因素, 与PHN的发生呈负相关.结论高龄和发病时疼痛严重的患者, 应注意预防PHN.神经阻滞有助于减少HZ患者住院天数, 缩短结痂时间, 降低PHN发生率.
- 带状疱疹 /
- 带状疱疹后神经痛 /
- 高危因素 /
- 神经阻滞
Abstract: Objective To investigate the effect of nerve block on the treatment of herpes zoster (HZ) and prevention of postherpetic neuralgia (PHN) , and to explore the factors that affect the occurrence of PHN.Methods From january 2015 to September 2016 in our hospital 80 acute HZ patients for the first time in the treatment of pain, were randomly assigned to the case group (nerve block + conventional medical treatment) 40 cases, and the control group (conventional medical treatment) 40 cases.The incidence of neuralgia in the two groups was analyzed, and the relationship between the age, sex, herpes, prodromal pain, initial pain, scab time, pain relief rate and PHN.Results PHN occurred in 4 cases (10.0%) in the case group and 19 cases (47.5%) in the control group (P <0.001) . (6.33 ± 0.86 days vs.7.15 ± 0.66 days, P <0.001) .The number of hospital days decreased (7.43 ± 1.80 days vs.12.90 ± 2.36 days, P <0.001) .Ageing (OR: 8.24, 95% CI:1.62-41.96) and prolonged crusting time (OR: 17.99, 95% CI: 2.14-151.43) , are risk factors for PHN, significantly increased the incidence of PHN.The VAS remission rate after 1 week (OR <0.000, 95% CI:0.000-0.001) was a protective factor for PHN and was negatively correlated with PHN.Conclusions Aging and onset of severe pain in patients should pay attention to the prevention of PHN.Nerve block helps to reduce the number of hospital stay in HZ patients, shorten the scab time, and reduce the incidence of PHN.
- Herpes zoster /
- Postherpetic neuralgia /
- High risk factors /
- Nerve block

HTML全文

参考文献(15)

[1]	[1]DWORKIN R H, PORTENOY R K.Pain and its persistence in herpes zoster[J].Pain, 1996, 67 (2-3) :241-251.[1]DWORKIN R H, PORTENOY R K.Pain and its persistence in herpes zoster[J].Pain, 1996, 67 (2-3) :241-251.
[2]	[2]KAWAI K, GEBREMESKEL B G, ACOSTA C J.Systematic review of incidence and complications of herpes zoster:towards a global perspective[J].BMJ Open, 2014, 4 (6) :e004833.[2]KAWAI K, GEBREMESKEL B G, ACOSTA C J.Systematic review of incidence and complications of herpes zoster:towards a global perspective[J].BMJ Open, 2014, 4 (6) :e004833.
[3]	[3]OXMAN M N, LEVIN M J, JOHNSON G R, et al.A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults[J].N Engl J Med, 2005, 352 (22) :2271-2284.[3]OXMAN M N, LEVIN M J, JOHNSON G R, et al.A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults[J].N Engl J Med, 2005, 352 (22) :2271-2284.
[4]	[4]KE M, YINGHUI F, YI J, et al.Efficacy of pulsed radiofrequency in the treatment of thoracic postherpetic neuralgia from the angulus costae:a randomized, double-blinded, controlled trial[J].Pain Physician, 2013, 16 (1) :15-25.[4]KE M, YINGHUI F, YI J, et al.Efficacy of pulsed radiofrequency in the treatment of thoracic postherpetic neuralgia from the angulus costae:a randomized, double-blinded, controlled trial[J].Pain Physician, 2013, 16 (1) :15-25.
[5]	[5]DROLET M, BRISSON M, SCHMADER K E, et al.The impact of herpes zoster and postherpetic neuralgia on health-related quality of life:a prospective study[J].CMAJ, 2010, 182 (16) :1731-1736.[5]DROLET M, BRISSON M, SCHMADER K E, et al.The impact of herpes zoster and postherpetic neuralgia on health-related quality of life:a prospective study[J].CMAJ, 2010, 182 (16) :1731-1736.
[6]	[6]SCHMADER K E.Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy[J].Clin J Pain, 2002, 18 (6) :350-354.[6]SCHMADER K E.Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy[J].Clin J Pain, 2002, 18 (6) :350-354.
[7]	[7]PHILIP A, THAKUR R.Post herpetic neuralgia[J].J Palliat Med, 2011, 14 (6) :765-773.[7]PHILIP A, THAKUR R.Post herpetic neuralgia[J].J Palliat Med, 2011, 14 (6) :765-773.
[8]	[8]KIM H J, AHN H S, LEE J Y, et al.Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster:a systematic review and meta-analysis[J].Korean J Pain, 2017, 30 (1) :3-17.[8]KIM H J, AHN H S, LEE J Y, et al.Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster:a systematic review and meta-analysis[J].Korean J Pain, 2017, 30 (1) :3-17.
[9]带状疱疹后神经痛诊疗共识编写专家组.带状疱疹后神经痛诊疗中国专家共识[J].中国疼痛医学杂志, 2016, 22 (3) :161-167.[9]带状疱疹后神经痛诊疗共识编写专家组.带状疱疹后神经痛诊疗中国专家共识[J].中国疼痛医学杂志, 2016, 22 (3) :161-167.
[10]	[10]ROWBOTHAM M C, DAVIES P S, FIELDS H L.Topical lidocaine gel relieves postherpetic neuralgia[J].Ann Neurol, 1995, 37 (2) :246-253.[10]ROWBOTHAM M C, DAVIES P S, FIELDS H L.Topical lidocaine gel relieves postherpetic neuralgia[J].Ann Neurol, 1995, 37 (2) :246-253.
[11]	[11]KOST R G, STRAUS S E.Postherpetic neuralgia--pathogenesis, treatment, and prevention[J].N Engl J Med, 1996, 335 (1) :32-42.[11]KOST R G, STRAUS S E.Postherpetic neuralgia--pathogenesis, treatment, and prevention[J].N Engl J Med, 1996, 335 (1) :32-42.
[12]	[12]DWORKIN R H, TURK D C, WYRWICH K W, et al.Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials:IMMPACT recommendations[J].J Pain, 2008, 9 (2) :105-121.[12]DWORKIN R H, TURK D C, WYRWICH K W, et al.Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials:IMMPACT recommendations[J].J Pain, 2008, 9 (2) :105-121.
[13]	[13]FORBES H J, THOMAS S L, SMEETH L, et al.A systematic review and meta-analysis of risk factors for postherpetic neuralgia[J].Pain, 2016, 157 (1) :30-54.[13]FORBES H J, THOMAS S L, SMEETH L, et al.A systematic review and meta-analysis of risk factors for postherpetic neuralgia[J].Pain, 2016, 157 (1) :30-54.
[14]	[14]JUNG B F, JOHNSON R W, GRIFFIN D R, et al.Risk factors for postherpetic neuralgia in patients with herpes zoster[J].Neurology, 2004, 62 (9) :1545-1551.[14]JUNG B F, JOHNSON R W, GRIFFIN D R, et al.Risk factors for postherpetic neuralgia in patients with herpes zoster[J].Neurology, 2004, 62 (9) :1545-1551.
[15]	[15]FORBES H J, BHASKARAN K, THOMAS S L, et al.Quantification of risk factors for postherpetic neuralgia in herpes zoster patients:A cohort study[J].Neurology, 2016, 87 (1) :94-102.[15]FORBES H J, BHASKARAN K, THOMAS S L, et al.Quantification of risk factors for postherpetic neuralgia in herpes zoster patients:A cohort study[J].Neurology, 2016, 87 (1) :94-102.

相关文章(20)

[1]	毛健宇, 陈建军, 阎静楠, 王泉, 詹力, 李石乔, 保文莉. 超声引导下肋间神经脉冲射频治疗胸椎高节段带状疱疹后神经痛的临床疗效, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20240514
[2]	刘亚南, 杨双, 彭煜航, 陈静, 徐世莲. 针刀疗法对神经痛大鼠的镇痛作用研究, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20231009
[3]	何花, 范晶华, 张燕玲, 李杨, 李海雯, 武彦. 免疫低下人群感染水痘-带状疱疹病毒38例的临床特征, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20220820
[4]	周银燕, 张宇, 白文娅, 沈艳娟, 邵建林, 赵国良. 直视下胸椎旁神经阻滞对胸科手术患者术后镇痛效果的影响, 昆明医科大学学报.
[5]	冉晓明, 宋瑞鹏, 孙丹. 影响肝癌肝部分切除术后患者合并感染发生的独立高危因素, 昆明医科大学学报.
[6]	张立, 董介轩, 殷志荣, 石小东, 李皎, 许燕飞, 刘维统, 董玮. 针刀松解对坐骨神经痛大鼠中枢镇痛机制, 昆明医科大学学报.
[7]	杜蓉, 徐碧芝. 脑梗死患者继发性癫痫发生情况及高危因素调查, 昆明医科大学学报.
[8]	张沛, 邢群智, 李毓, 韩学昌, 董旭, 常俊晓. 电针镇痛治疗带状疱疹后神经痛的临床疗效, 昆明医科大学学报.
[9]	李星, 梁红敏, 朱梅, 何敏, 曹维涵. 超声引导下星状神经节阻滞治疗失眠症疗效和安全性评价, 昆明医科大学学报.
[10]	康青乐, 李亚平. 头皮神经阻滞复合七氟醚在颅脑手术中的临床应用, 昆明医科大学学报.
[11]	庞佳宁, 刘劲松, 李溪, 王莉竹, 张锡华. TKA术后连续股神经阻滞早期镇痛疗效, 昆明医科大学学报.
[12]	温开兰. 股神经阻滞自控镇痛在全膝关节置换术后镇痛中的应用, 昆明医科大学学报.
[13]	陈永伦. 椎旁神经阻滞复合全麻在胸科手术中的应用, 昆明医科大学学报.
[14]	饶燕. 600例剖宫产术后腹部切口愈合情况观察分析, 昆明医科大学学报.
[15]	李明. 超声引导联合神经刺激器在上肢臂丛神经阻滞的临床研究, 昆明医科大学学报.
[16]	凌开建. 胎盘早剥45例病因及临床分析, 昆明医科大学学报.
[17]	闫晋. 臂丛神经两点阻滞法的安全性和有效性, 昆明医科大学学报.
[18]	. 小剂量氯胺酮治疗慢性顽固性灼性神经痛1例报道, 昆明医科大学学报.
[19]	徐阳. 伽玛刀治疗原发性三叉神经痛46例分析, 昆明医科大学学报.
[20]	. 龙血竭胶囊在带状疱疹的局部治疗及护理, 昆明医科大学学报.