皮神经阻滞对带状疱疹神经痛临床转归的影响
发布时间：2019-05-21 17:34
【摘要】：背景:带状疱疹患者出现受累组织和神经局部免疫炎性反应过度,神经末梢出现病理性损伤,带状疱疹急性期疼痛程度与外周神经末梢及神经节的炎性反应和组织损伤程度有关。对受损皮肤行组织活检也发现,免疫性炎性反应在病变早期对外周神经的损害。周围神经的病理性改变及神经冲动传导异常,导致外周和中枢神经系统功能发生各种病理性变化,促成带状疱疹后遗神经痛的持续性或多方式的疼痛状态。有关临床观察发现对带状疱疹皮损区进行皮神经阻滞可以加快皮损区的结痂和愈合过程。 目的:临床观察评价在带状疱疹急性期通过皮神经阻滞是否可有效地抑制外周神经免疫性炎性反应,从而控制带状疱疹所致的神经源性疼痛。 方法:选取带状疱疹病人72人,随机分为2组:皮神经阻滞组(L组,n=36),再将该组分为2组:L1组(n=18,受累皮损病变期)和L2组(n=18,受累皮损愈合期);保守药物治疗组(N组,n=36),再分为N1组(n=18,受累皮损病变期)和N2组(n=18,受累皮损愈合期)。L组应用0.3%利多卡因+腺苷钴胺0.5mg+甲强龙40mg,总量10-15ml,在皮损最严重或疼痛最明显的皮肤受累区,自神经分布近端至远端进行皮下阻滞;N组常规应用口服抗病毒药物、维生素B12、镇痛药物及在皮损区外用药物。观察项目包括两方面内容:◇不同治疗方法对带状疱疹皮肤损害期皮损愈合的影响;◇受累神经区不同治疗组治疗前后疼痛程度及性质改变及其与PHN发病的相关性分析。 结果: 一、各组患者一般情况及皮损范围、疼痛程度、治疗前发病时间等比较无统计学差异(见表1) 二、不同治疗方法对带状疱疹急性期皮肤损害愈合的影响 在带状疱疹受累皮损病变期应用两种方法治疗,比较皮损区结痂时间和疼痛缓解程度(见表2),两组治疗时间均为四周;临床观察发现: 1、两治疗组自皮疹出现至介入治疗的时间比较无统计学意义(p0.05); 2、不同皮损范围皮损结痂时间比较: ①两治疗组组间,相同皮损面积结痂时间比较显示,L1组较N1组明显提前,(P0.05); ②两治疗组组内,不同皮损面积比较显示,皮损面积越小,结痂时间越早,各组皮损范围1%与2%比较均有显著性差异(P0.05); ③VAS疼痛评分在两治疗组组间总体比较, L1组较N1组疼痛程度明显降低,(P0.05); ④两治疗组组内,不同皮损范围组比较,皮损范围越小,疼痛程度缓解越明显(P0.05)。 三、受累神经区不同治疗组治疗前后疼痛情况比较(见表3、4、5、6) 1、受累神经支配区疼痛性质多为持续灼痛、痛觉异常、感觉迟钝和自发痛。 2、不同治疗方法对受累神经疼痛性质变化影响的总体比较 a)两种治疗方法治疗前后比较显示,疼痛性质的改变均有显著性差异(p0.05)。 b)治疗后四周L组和N组总体比较显示:L组持续灼痛、痛觉异常、自发痛比率均有明显下降(p0.05),感觉迟钝比率明显增加(p0.05)。 3、L组和N组总体VAS疼痛评分比较显示,治疗后两组较治疗前疼痛程度明显降低,L组疼痛程度明显低于N组,p0.05,有统计学意义。 4、受累皮区急性期和结痂期介入治疗后神经疼痛性质变化的比较 ①L1组和L2组:L1组持续灼痛比率明显低于L2组(p0.05),痛觉异常和感觉迟钝比率无明显差异,自发痛比率L2组稍有增加,但无统计学意义; ②N1组和N2组: N1组持续灼痛和痛觉异常比率明显低于N2组(p0.05),感觉迟钝和自发痛比率两组无明显差异。 5、受累皮损病变期介入治疗N1组+L1组与受累皮损愈合期介入治疗N2组+L2组疗效比较:N1组+L1组持续灼痛和痛觉异常比率明显低于N2组+L2组(p0.05);N1组+L1组感觉迟钝比率无明显增加,自发痛比率有显著减少(p0.05)。 结论: 1、早期应用阻滞治疗方法可以有效抑制带状疱疹皮损区免疫炎性反应,使局部皮损早期结痂愈合; 2、早期应用阻滞治疗方法,可以促使疼痛性质类型发生改变,并明显减低带状疱疹受累区的疼痛程度; 3、两种治疗方法结果均显示,皮损面积越小,治疗效果越显著 4、两种治疗方法结果均显示,在带状疱疹皮损早期介入治疗可以更有效地控制疼痛症状。
[Abstract]:Background: In the patients with herpes zoster, the involvement of the affected tissues and the local immune inflammatory reaction of the nerve is excessive, pathological damage occurs in the nerve endings, and the degree of pain in the acute stage of the herpes zoster is related to the inflammatory reaction and the degree of tissue injury of the peripheral nerve endings and the ganglion. The tissue biopsy of the injured skin also found that the immune inflammatory reaction was damaged at the early stage of the lesion in the early stage of the lesion. The pathological change of the peripheral nerve and the abnormal nerve impulse conduction cause various pathological changes in the function of the peripheral and central nervous system, leading to the persistent or multi-mode pain state of the postherpetic neuralgia. It is found that the skin nerve block in the area of the skin of the herpes zoster can accelerate the healing and healing process of the lesion area. Objective: To evaluate whether the peripheral neuroimmune inflammatory reaction can be effectively inhibited in the acute phase of herpes zoster by clinical observation, so as to control the neurogenic pain caused by herpes zoster. Methods:72 patients with herpes zoster were randomly divided into 2 groups: skin nerve block group (L group, n = 36), and then the group was divided into two groups: L1 group (n = 18, lesion of affected skin lesion) and L2 group (n = 18, affected skin lesion healing period), and conservative drug treatment group (N group, n = 36), and then into the N1 group (n = 18, the lesion of the affected skin lesion) and the N2 group (n = 18, the higher the affected lesion). In group L, 0.3% lidocaine + adenoid cobalamin 0.5 mg + methylprednisolone 40 mg, total amount of 10-15 ml, the most severe or painful skin involvement area in the skin lesion, the subcutaneous block from the proximal to distal end of the nerve distribution, and the routine application of oral antiviral drugs and vitamins in the N group. B12, analgesic, and out of the skin The effect of different treatment methods on the healing of the skin lesions in the skin of the herpes zoster caused by different treatment methods, and the change of the degree of pain and the nature of the treatment group before and after the treatment of the affected nerve area and the correlation with the onset of PHN sex analysis Results:1. The general situation of the patients and the range of the lesions, the degree of pain, the time of treatment before treatment and the like were not statistically significant. the difference of learning The difference (see Table 1)2. The different treatment methods are acute to herpes zoster. The effects of the period of skin lesion healing on the healing of the skin lesions in the patients with herpes zoster were treated by two methods, and the time and the degree of pain relief in the lesion area were compared (see Table 2), and the treatment time of the two groups are all Four weeks; clinical observations found:1. The time between the two treatment groups from the onset of the rash to the interventional treatment No statistical significance (p0.05);2 The results of the comparison between the two treatment groups and the area of the same skin lesion were shown in this paper. Compared with the N1 group, the area of the lesions of the two groups was significantly advanced (P0.05), and the area of the lesions in the two treatment groups showed that the smaller the area of the lesions, the earlier the junction time, and 1% of the lesions in each group. There was a significant difference between 2% and 2% (P0.05). The overall comparison of the VAS pain score between the two treatment groups, L1 The degree of pain in the group was significantly lower than that in the N1 group (P0.05); in the group of the two treatment groups, the range group of different skin lesions was compared, The smaller the range of lesions, the more obvious the degree of pain (P0.05). Comparison of pain before and after treatment in different treatment groups (see Table 3,4,5,6)1, affected nerve The pain of the dominant region is a persistent burning pain, a hyperalgesia, a dull and spontaneous feeling. Pain.2. The general comparison of the effect of different treatment methods on the change in the nature of the affected nerve pain (a) the two treatment parties The results showed that the changes of pain were significantly different before and after the treatment (p0.05). b) The overall comparison of the groups of L and N after treatment showed that the L group had persistent burning pain, hyperalgesia, and spontaneous pain. There was a significant decrease in the ratio (p0.05), and the rate of hypoesthesia was significantly increased (p0.05). The overall VAS pain scores in the 3, L and N groups were compared and the two groups were treated after treatment. The degree of pain in the L group was significantly lower than that of the N group, and the pain degree in the L group was significantly lower than that of the N group, p0.05, Statistical significance.4. Comparison of the changes in the nature of the neuropain following the interventional treatment of the affected skin region at the acute and junction stage: the ratio of the continuous burning pain in the L1 group was significantly lower than that of the L Group 2 (p0.05) ). There was no significant difference in the ratio of hyperalgesia and the rate of hypoesthesia. There was a slight increase in the ratio of the spontaneous pain to the L2 group, but there was no statistical significance; the N1 and the N2 groups: the N1 group continued. The rate of burning pain and hyperalgesia was significantly lower than that of the N2 group (p0.05). There was no significant difference between the two groups. the hyperalgesia ratio is significantly lower than the n2 group + l2 group ( P0. There was no significant increase in the rate of insensitivity in the group of N1 and L1, and there was a significant decrease in the rate of spontaneous pain (p0.05). 1. The early application of block treatment can effectively inhibit the skin lesions of herpes zoster. Regional immune inflammatory response, and the early junction of the local skin lesions in combination;2, that early application of a block of treatment may cause a type of pain nature to be has changed, and obviously reduces the pain degree of the affected area of the herpes zoster; and 3, the results of the two treatment methods all show that the skin lesion
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R752.12
本文编号：2482264
[Abstract]:Background: In the patients with herpes zoster, the involvement of the affected tissues and the local immune inflammatory reaction of the nerve is excessive, pathological damage occurs in the nerve endings, and the degree of pain in the acute stage of the herpes zoster is related to the inflammatory reaction and the degree of tissue injury of the peripheral nerve endings and the ganglion. The tissue biopsy of the injured skin also found that the immune inflammatory reaction was damaged at the early stage of the lesion in the early stage of the lesion. The pathological change of the peripheral nerve and the abnormal nerve impulse conduction cause various pathological changes in the function of the peripheral and central nervous system, leading to the persistent or multi-mode pain state of the postherpetic neuralgia. It is found that the skin nerve block in the area of the skin of the herpes zoster can accelerate the healing and healing process of the lesion area. Objective: To evaluate whether the peripheral neuroimmune inflammatory reaction can be effectively inhibited in the acute phase of herpes zoster by clinical observation, so as to control the neurogenic pain caused by herpes zoster. Methods:72 patients with herpes zoster were randomly divided into 2 groups: skin nerve block group (L group, n = 36), and then the group was divided into two groups: L1 group (n = 18, lesion of affected skin lesion) and L2 group (n = 18, affected skin lesion healing period), and conservative drug treatment group (N group, n = 36), and then into the N1 group (n = 18, the lesion of the affected skin lesion) and the N2 group (n = 18, the higher the affected lesion). In group L, 0.3% lidocaine + adenoid cobalamin 0.5 mg + methylprednisolone 40 mg, total amount of 10-15 ml, the most severe or painful skin involvement area in the skin lesion, the subcutaneous block from the proximal to distal end of the nerve distribution, and the routine application of oral antiviral drugs and vitamins in the N group. B12, analgesic, and out of the skin The effect of different treatment methods on the healing of the skin lesions in the skin of the herpes zoster caused by different treatment methods, and the change of the degree of pain and the nature of the treatment group before and after the treatment of the affected nerve area and the correlation with the onset of PHN sex analysis Results:1. The general situation of the patients and the range of the lesions, the degree of pain, the time of treatment before treatment and the like were not statistically significant. the difference of learning The difference (see Table 1)2. The different treatment methods are acute to herpes zoster. The effects of the period of skin lesion healing on the healing of the skin lesions in the patients with herpes zoster were treated by two methods, and the time and the degree of pain relief in the lesion area were compared (see Table 2), and the treatment time of the two groups are all Four weeks; clinical observations found:1. The time between the two treatment groups from the onset of the rash to the interventional treatment No statistical significance (p0.05);2 The results of the comparison between the two treatment groups and the area of the same skin lesion were shown in this paper. Compared with the N1 group, the area of the lesions of the two groups was significantly advanced (P0.05), and the area of the lesions in the two treatment groups showed that the smaller the area of the lesions, the earlier the junction time, and 1% of the lesions in each group. There was a significant difference between 2% and 2% (P0.05). The overall comparison of the VAS pain score between the two treatment groups, L1 The degree of pain in the group was significantly lower than that in the N1 group (P0.05); in the group of the two treatment groups, the range group of different skin lesions was compared, The smaller the range of lesions, the more obvious the degree of pain (P0.05). Comparison of pain before and after treatment in different treatment groups (see Table 3,4,5,6)1, affected nerve The pain of the dominant region is a persistent burning pain, a hyperalgesia, a dull and spontaneous feeling. Pain.2. The general comparison of the effect of different treatment methods on the change in the nature of the affected nerve pain (a) the two treatment parties The results showed that the changes of pain were significantly different before and after the treatment (p0.05). b) The overall comparison of the groups of L and N after treatment showed that the L group had persistent burning pain, hyperalgesia, and spontaneous pain. There was a significant decrease in the ratio (p0.05), and the rate of hypoesthesia was significantly increased (p0.05). The overall VAS pain scores in the 3, L and N groups were compared and the two groups were treated after treatment. The degree of pain in the L group was significantly lower than that of the N group, and the pain degree in the L group was significantly lower than that of the N group, p0.05, Statistical significance.4. Comparison of the changes in the nature of the neuropain following the interventional treatment of the affected skin region at the acute and junction stage: the ratio of the continuous burning pain in the L1 group was significantly lower than that of the L Group 2 (p0.05) ). There was no significant difference in the ratio of hyperalgesia and the rate of hypoesthesia. There was a slight increase in the ratio of the spontaneous pain to the L2 group, but there was no statistical significance; the N1 and the N2 groups: the N1 group continued. The rate of burning pain and hyperalgesia was significantly lower than that of the N2 group (p0.05). There was no significant difference between the two groups. the hyperalgesia ratio is significantly lower than the n2 group + l2 group ( P0. There was no significant increase in the rate of insensitivity in the group of N1 and L1, and there was a significant decrease in the rate of spontaneous pain (p0.05). 1. The early application of block treatment can effectively inhibit the skin lesions of herpes zoster. Regional immune inflammatory response, and the early junction of the local skin lesions in combination;2, that early application of a block of treatment may cause a type of pain nature to be has changed, and obviously reduces the pain degree of the affected area of the herpes zoster; and 3, the results of the two treatment methods all show that the skin lesion
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R752.12
【参考文献】
相关期刊论文 前6条
1 林献忠;疼痛、镇痛与免疫[J];国外医学.麻醉学与复苏分册;2003年02期
2 孙建方,徐秀莲;带状疱疹后遗神经痛的治疗现状[J];实用老年医学;2004年06期
3 杨亚东;伍津津;毕建军;鲁元刚;朱堂友;;带状疱疹后遗神经痛178例特征回顾[J];中国临床康复;2005年37期
4 黄仕荣;;针刺促微循环镇痛机制研究与思考[J];中国中医药信息杂志;2006年02期
5 肖红;李茜;刘慧;文传兵;孙琳;杨邦祥;;神经阻滞治疗带状疱疹神经痛临床疗效观察[J];实用医院临床杂志;2008年01期
6 张斌;王卓强;何建苗;胡玉东;;抗病毒联合皮下及肋间神经阻滞治疗带状疱疹痛[J];中国疼痛医学杂志;2006年03期
，本文编号：2482264
本文链接：https://www.wllwen.com/yixuelunwen/pifb/2482264.html
最近更新
教材专著
