脈沖聯(lián)合表阿霉素神經(jīng)后支毀損治療帶狀皰疹后神經(jīng)痛的臨床效果分析

王曉英　王玲　李娟娟　雷晴宇　毛振北　曹正培

【摘要】 目的：探討脈沖聯(lián)合表阿霉素神經(jīng)后支毀損治療帶狀皰疹后神經(jīng)痛的臨床療效。方法：選取2016年5月-2017年6月本院收治的帶狀皰疹后神經(jīng)痛患者80例為研究對(duì)象，均行脈沖聯(lián)合表阿霉素神經(jīng)后支毀損治療，觀察患者不同時(shí)間段VAS評(píng)分、PSQI評(píng)分和臨床療效，同時(shí)記錄患者術(shù)后可能發(fā)生的并發(fā)癥。結(jié)果：患者術(shù)后即刻、術(shù)后1周、術(shù)后3個(gè)月及術(shù)后6個(gè)月的VAS評(píng)分和PSQI評(píng)分均明顯低于術(shù)前，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）；患者術(shù)后3個(gè)月顯效率為94%，明顯高于術(shù)后即刻的70%，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；無(wú)一例患者出現(xiàn)感染、氣胸、呼吸循環(huán)抑制等并發(fā)癥。結(jié)論：脈沖聯(lián)合表阿霉素神經(jīng)后支毀損在運(yùn)用表阿霉素毒性作用使神經(jīng)變性作用的同時(shí)，通過(guò)神經(jīng)調(diào)控產(chǎn)生生物學(xué)效應(yīng)，調(diào)控中樞神經(jīng)的疼痛介質(zhì)以改善中樞敏化，有效緩解帶狀皰疹后神經(jīng)痛的臨床癥狀，提高患者生活水平，具有重要的臨床意義，值得推廣和應(yīng)用。

【關(guān)鍵詞】 脈沖； 表阿霉素； 帶狀皰疹后神經(jīng)痛

Pulse Combined with Epirubicin Nerve Ablation in the Treatment of Postherpetic Neuralgia/WANG Xiaoying，WANG Ling，LI Juanjuan，et al.//Medical Innovation of China，2017，14（32）：123-126

【Abstract】 Objective：To investigate the effect of pulse combined with Epirubicin nerve ablation in the treatment of postherpetic neuralgia.Method：80 patients with postherpetic neuralgia treated in our hospital from May 2016 to June 2017 were selected as the subjects，they were given pulse combined with Epirubicin nerve ablation and the VAS score at different times was observed，PSQI score，clinical efficacy and the possible complications after the operation were recorded.Result：VAS scores and PSQI scores of the patients immediately，1 week after operation，3 months after operation and 6 months after operation were significantly lower than those of before the operation，the difference were significant（P<0.05）.The effective rate was 94% at 3 months after operation，significantly higher than 70% of immediately after surgery，the difference was significant（P<0.05）.There were no complications such as infection，pneumothorax，respiratory and circulatory depression in 1 case.Conclusion：Pulse combined with epirubicin nerve damage in the use of toxic effects of Epirubicin make neurodegenerative effects.At the same time，the biological effect of the nerve regulation，regulate the pain medium of central nervous system to improve central sensitization，the clinical symptoms of postherpetic neuralgia are effectively relieved，improving the living standard of the patients.

【Key words】 Pulse； Epirubicin； Postherpetic neuralgia

First-authors address：The First Peoples Hospital of Jiujiang，Jiujiang 332000，China

doi：10.3969/j.issn.1674-4985.2017.32.031

帶狀皰疹后神經(jīng)痛屬于慢性神經(jīng)病理性疼痛，主要是由于皰疹病毒侵犯神經(jīng)引起的神經(jīng)源性疼痛，好發(fā)于三叉神經(jīng)和肋間神經(jīng)[1]，該疾病多見(jiàn)于50歲以上的老年人。其中約有20%的帶狀皰疹患者伴有神經(jīng)痛后遺癥，而50歲以上的患者中，約有62%患者會(huì)遺留神經(jīng)痛，比例明顯增高[2]。在疾病的發(fā)展過(guò)程中，帶狀皰疹后神經(jīng)痛可逐漸加重，出現(xiàn)痛覺(jué)過(guò)敏、痛覺(jué)異常或正常感覺(jué)的改變，臨床主要表現(xiàn)為局部的刺痛、灼痛、跳痛或者刀割痛，具有陣發(fā)性和持續(xù)性，嚴(yán)重影響患者的睡眠及日常生活，甚者可導(dǎo)致抑郁。帶狀皰疹后神經(jīng)痛可分為急性、亞急性和慢性3個(gè)階段，其病理改變最主要表現(xiàn)為神經(jīng)元和相應(yīng)神經(jīng)纖維炎性浸潤(rùn)、出血性壞死及神經(jīng)脫髓鞘改變[3]。目前臨床治療方向主要為在疾病早期進(jìn)行抑制性治療，從而降低后遺癥的發(fā)生率。隨著疼痛學(xué)科的發(fā)展，微創(chuàng)技術(shù)已被廣泛應(yīng)用于神經(jīng)痛疾病的治療中。……