神经病理性疼痛患者的临床调查分析

发布时间：2018-05-31 22:16

本文选题：神经病理性疼痛 + 带状疱疹后神经痛　；参考：《苏州大学》2014年硕士论文

【摘要】：目的：通过对神经病理性疼痛患者的临床特点及治疗转归进行分析，以加深对神经病理性疼痛认识，并为进一步指导临床治疗提供帮助。方法：本研究共收集神经内科门诊确诊的196例神经病理性疼痛患者的临床资料，详细记录患者一般情况（性别、年龄、文化程度、职业状况等）、疼痛的类型、病程、临床表现，用视觉模拟量表评估疼痛强度、睡眠及情绪障碍程度，记录药物治疗情况及治疗转归。对单用普瑞巴林或加巴喷丁治疗的带状疱疹后神经痛患者，采用视觉模拟量表评估两组患者治疗前及治疗后第1周、第2周、第4周和第8周的疼痛强度及睡眠和情绪障碍程度，比较其疗效，并记录不良反应发生率。结果：196例神经病理性疼痛患者中，周围性神经病理性疼痛172例（87.8%）明显多于中枢性神经病理性疼痛19例（9.7%)，且治愈率（33.1%）明显高于后者（0.0%）（χ2=8.975，p=0.001)。中老年人更易发生神经病理性疼痛，50岁以上患者所占比例78.6%。病程从7天到10年不等，86.2%患者病程超过30天；88.3%患者表现为中至重度疼痛，66.3%患者合并不同程度睡眠或情绪障碍。经治疗，所有患者疼痛视觉模拟量表（VAS）评分（2.17+1.64）较治疗前基线期（6.63+1.41）显著降低（p=0.000）；与治疗前相比，睡眠及情绪障碍评分均显著改善（p0.05）。196例患者中33例（16.8%）完全治愈；23例（11.8%）显著有效；101例（51.5%）有效；39例（19.9%）患者无效；临床总有效率为80.1%；仅22例（11.2%）患者出现短时头晕、乏力、外周水肿等不良反应。单独使用普瑞巴林或加巴喷丁的带状疱疹后神经痛者，治疗后两组患者疼痛VAS评分、情绪及睡眠状态VAS评分均较治疗前有明显改善，且普瑞巴林治疗组各时间点的观察指标均优于加巴喷丁组（p0.05）；两组不良反应发生率差别无统计学意义（χ2=1.412,p=0.235）。结论：神经病理性疼痛病因复杂多样，周围性神经病理性疼痛占多数。中老年人群患病率较高，疼痛剧烈且持续时间长，常合并情绪及睡眠障碍，，严重影响患者生活质量，临床治愈率低。普瑞巴林和加巴喷丁治疗带状疱疹后神经痛均可获得比较满意的疗效，普瑞巴林疗效更优。
[Abstract]:Objective: to analyze the clinical characteristics and therapeutic outcome of neuropathic pain patients in order to deepen the understanding of neuropathic pain and provide help for clinical treatment. Methods: the clinical data of 196 patients with neuropathic pain were collected and recorded in detail (sex, age, education, occupational status, type of pain, course of disease, clinical manifestation). Visual analogue scale was used to evaluate the intensity of pain, sleep and mood disorder, and to record the drug treatment and outcome. In patients with postherpetic neuralgia treated with PreBahrain or gabapentin alone, visual analogue scale was used to evaluate the first and second week before and after treatment in both groups. Pain intensity and degree of sleep and mood disorders were compared between week 4 and week 8, and the incidence of adverse reactions was recorded. Results among 196 patients with neuropathic pain, 172 patients with peripheral neuropathic pain were significantly higher than those with central neuropathic pain in 19 patients with neuropathic pain, and the cure rate was significantly higher than that in the latter group. Neuropathic pain was more common in middle aged and elderly patients than in patients over 50 years old. The course of disease ranged from 7 days to 10 years. 86.2% of the patients showed moderate to severe pain and 66.3% of them had different degrees of sleep or mood disorder. After treatment, the VAS score of all patients was 2.17 1.64) significantly lower than that of baseline period 6.63 1.41). The scores of sleep and mood disorders were significantly improved in 33 patients (16.8g / 196) and completely cured (11.8%). 101 cases (51.5%) were effective. 39 cases (19.9%) were ineffective. The total clinical effective rate was 80.1%; only 22 cases had short-term dizziness and fatigue. Peripheral edema and other adverse reactions. The pain VAS scores, mood and sleep state VAS scores of patients treated with PreBahrain or gabapentin alone were significantly improved compared with those before treatment. The observation index of each time point in PreBahrain treatment group was better than that in gabapentin group (P 0.05), and there was no significant difference in the incidence of adverse reactions between the two groups (蠂 ~ 2 ~ 2 ~ (1.412) P ~ + 0.235). Conclusion: the etiology of neuropathic pain is complex and varied, and peripheral neuropathic pain is the majority. The prevalence rate of middle and old people is high, the pain is severe and lasting for a long time, often accompanied by emotional and sleep disorders, which seriously affects the quality of life of patients, and the clinical cure rate is low. PreBahrain and gabapentin are more satisfactory in the treatment of post herpes zoster neuralgia, and PreBahrain is better in the treatment of post herpes zoster neuralgia.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R741

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