超声引导下神经阻滞治疗带状疱疹性神经痛的效果观察

doi:10.7517/issn.1674-0475.221104

摘要/Abstract

摘要： 本研究探讨超声引导下神经阻滞治疗急性带状疱疹性神经痛的效果及对患者血清免疫应答分子的影响。选取80例急性带状疱疹性神经痛患者进行研究，将患者随机分为观察组和对照组，每组各40例，观察组采用超声引导下肋间神经阻滞治疗+口服镇痛药物及抗病毒药物治疗，对照组采用口服镇痛药物及抗病毒药物治疗。观察组患者的操作时间、阻滞起效时间均低于对照组，观察组的首次穿刺成功率高于对照组（P<0.05）；观察组和对照组的VAS评分均随着治疗时间逐渐降低，且观察组的VAS评分在治疗后第1～4周时刻均低于对应时间点的对照组（P<0.05）；治疗4周后，观察组的血清免疫球蛋白G （IgG）高于对照组（P<0.05）；观察组的白细胞介素（IL）-10、IL-26、高迁移率族蛋白1（HMGB1）及CXC趋化因子配体10（CXCL-10）水平均低于对照组（P<0.05）。超声引导下肋间神经阻滞可减少操作时间，提高首次穿刺成功率，更有效地缓解患者的疼痛、改善患者免疫功能、调控相关细胞因子水平。

关键词: 超声, 神经阻滞, 带状疱疹, 神经痛, 免疫球蛋白, 白细胞介素, 高迁移率族蛋白1, CXC趋化因子配体10

Abstract: This study investigated the effect of ultrasound-guided nerve block in the treatment of acute herpes zoster herpetic neuralgia and its effect on serum immune response molecules. 80 patients with acute herpetic neuralgia were selected and randomly divided into observation group and control group, 40 cases in each group. The observation group was treated with ultrasound-guided intercostal nerve block plus oral analgesic drugs and antiviral drugs, while the control group was treated with oral analgesic drugs and antiviral drugs. The operation time and block onset time of the observation group were lower than those of the control group, and the first puncture success rate of the observation group was higher than that of the control group (P<0.05). The VAS scores of the observation group and the control group were decreased with the treatment time, and the VAS scores of the observation group were lower than those of the control group at the corresponding time points from the 1st week to the 4th week after treatment (P<0.05). After 4 weeks of treatment, the serum immunoglobulin G (IgG) of the observation group was higher than that of the control group (P<0.05). The levels of interleukin (IL) -10, IL-26, high mobility group protein 1 (HMGB1) and CXC chemokine ligand 10 (CXCL-10) in the observation group were lower than those in the control group (P<0.05). Ultrasound-guided intercostal nerve block can reduce the operation time, improve the success rate of the first puncture, more effectively relieve the patient's pain, improve the patient's immune function, and regulate the level of related cytokines.

Key words: ultrasound, nerve block, herpes zoster, neuralgia, immunoglobulin, interleukin, high mobility group protein 1, CXC chemokine ligand 10

刘闯, 武勇, 丁孟瑶. 超声引导下神经阻滞治疗带状疱疹性神经痛的效果观察[J]. 影像科学与光化学, 2023, 41(1): 64-68.

LIU Chuang, WU Yong, DING Mengyao. Effect Observation of Ultrasound-guided Nerve Block on Treating Herpes Zoster Neuralgia[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2023, 41(1): 64-68.

参考文献

[1] 李娜. 身痛逐瘀汤配合神经阻滞治疗带状疱疹后遗神经痛临床疗效及生活质量的影响[J]. 中国中医急症,2016,25(7):1420-1422.
[2] 于晓燕, 宋杰. 盐酸度洛西汀联合神经阻滞治疗带状疱疹后神经痛疗效观察[J]. 现代中西医结合杂志, 2017, 26(3):295-297.
[3] 夏菊荣, 杜忠举. 普瑞巴林联合超声引导下椎旁神经阻滞对带状疱疹后遗神经痛治疗效果的临床研究[J]. 中国医师杂志, 2017, 19(10):1570-1572.
[4] 史海军, 崔志强. 带状疱疹急性期患者血清炎性因子、免疫球蛋白含量与后遗神经痛的相关性[J]. 海南医学院学报, 2017, 23(1):89-92.
[5] 张学军, 陆洪光, 高兴华. 皮肤性病学[M]. 8版. 北京:人民卫生出版社, 2013:3.
[6] 张社会, 左珊珊. 超激光照射联合超声引导下胸椎旁神经阻滞治疗带状疱疹后遗神经痛的疗效观察[J]. 中华物理医学与康复杂志, 2017, 39(10):783-784.
[7] 杜红. 带状疱疹急性期皮神经阻滞对带状疱疹神经痛影响[J]. 现代仪器与医疗, 2016, 22(6):67-68, 71.
[8] 马志军, 臧颖卓, 王清涛, 等. 神经阻滞联合加巴喷丁治疗带状疱疹后神经痛的观察[J]. 脑与神经疾病杂志, 2016, 24(4):232-235.
[9] Friesen K J, Chateau D, Falk J, et al. Cost of shingles:Population based burden of disease analysis of herpes zoster and postherpetic neuralgia[J]. BMC Infectious Diseases, 2017, 17(1):69.
[10] 王康, 贾和平, 任彦景. 椎旁神经阻滞联合皮内阻滞治疗带状疱疹后神经痛近期疗效观察[J]. 中国疼痛医学杂志, 2017, 23(11):868-871.
[11] 刘鸽, 金茹. 超声引导下肋锁间隙与肌间沟入路臂丛神经阻滞方案对前臂手术患者术中及术后镇痛效果的影响[J]. 当代医学, 2022, 28(12):119-121.
[12] 薛金配, 杨婷, 余学刚, 等. 超声引导下肋锁间隙径路臂丛神经阻滞0.375%罗哌卡因最低有效剂量的临床研究[J]. 国际医药卫生导报, 2021, 27(9):1373-1377.
[13] 申海燕, 袁燕, 孙灿林, 等. 神经阻滞疗法治疗带状疱疹后神经痛的研究进展[J]. 中国疼痛医学杂志, 2017, 23(1):59-63.
[14] 曹梦. 毫火针点刺联合夹脊电针治疗带状疱疹神经痛的疗效及其对血清IgM、IgG、IgA的影响[D]. 武汉:湖北中医药大学, 2018.
[15] 卫琰, 陈弘, 张昕, 等. 超声引导下胸椎旁神经阻滞对老年带状疱疹后神经痛的疗效分析[J]. 中国疼痛医学杂志, 2016, 22(7):510-513.
[16] 陈明慧, 俞红丽, 常涛, 等. 经臀入路阴部神经阻滞用于会阴区带状疱疹后神经痛[J]. 中国疼痛医学杂志, 2017, 23(9):716-717, 720.