CAJ | 학술논문

目的评价CT引导下局部注射多柔比星毁损背根神经节对胸背部带状疱疹后神经痛患者的效果.方法胸背部带状疱疹后神经痛患者150例,采用随机数字表法,将其随机分为3组(n=50):单纯口服药物治疗组(A组)、C型臂引导下局部注射多柔比星毁损背根神经节组(B组)和CT引导下局部注射多柔比星毁损背根神经节组(C组).B组和C组在口服药物的基础上分别在C型臂和CT引导下毁损背根神经节,根据躯体神经的节段性分布选择疱疹病毒侵犯最重的3个节段脊神经.穿刺成功后,在每个节段注射试验剂量1%利多卡因1 ml,15 min后注射复方倍他米松4.7 mg和多柔比星3.3 mg.局部给药后根据疼痛程度继续口服羟考酮缓释片和加巴喷丁.记录患者因药物副作用退出情况.分别于局部给药前、局部给药后24 h、1周、1、3、6个月进行VAS评分、睡眠干扰评分(SIS)和简化麦吉尔评分(SF-MPQ),并记录上述各时点口服药物剂量及局部给药后12 h内气胸的发生情况.结果与A组比较,B组和C组因药物副作用退出率、VAS评分、SIS评分和SF-MPQ总分、羟考酮缓释片和加巴喷丁的剂量均降低(P＜0.05);B组与C组间上述指标比较差异无统计学意义(P＞0.05).B组气胸发生率为10%,C组无一例发生气胸,C组气胸发生率低于B组(P＜0.05).结论 CT引导下局部注射多柔比星毁损背根神经节可有效地减轻胸背部带状疱疹后神经痛患者疼痛,且安全性良好.
목적 평개CT인도하국부주사다유비성훼손배근신경절대흉배부대상포진후신경통환자적효과.방법 흉배부대상포진후신경통환자150례,채용수궤수자표법,장기수궤분위3조(n=50):단순구복약물치료조(A조)、C형비인도하국부주사다유비성훼손배근신경절조(B조)화CT인도하국부주사다유비성훼손배근신경절조(C조).B조화C조재구복약물적기출상분별재C형비화CT인도하훼손배근신경절,근거구체신경적절단성분포선택포진병독침범최중적3개절단척신경.천자성공후,재매개절단주사시험제량1%리다잡인1 ml,15 min후주사복방배타미송4.7 mg화다유비성3.3 mg.국부급약후근거동통정도계속구복간고동완석편화가파분정.기록환자인약물부작용퇴출정황.분별우국부급약전、국부급약후24 h、1주、1、3、6개월진행VAS평분、수면간우평분(SIS)화간화맥길이평분(SF-MPQ),병기록상술각시점구복약물제량급국부급약후12 h내기흉적발생정황.결과 여A조비교,B조화C조인약물부작용퇴출솔、VAS평분、SIS평분화SF-MPQ총분、간고동완석편화가파분정적제량균강저(P＜0.05);B조여C조간상술지표비교차이무통계학의의(P＞0.05).B조기흉발생솔위10%,C조무일례발생기흉,C조기흉발생솔저우B조(P＜0.05).결론 CT인도하국부주사다유비성훼손배근신경절가유효지감경흉배부대상포진후신경통환자동통,차안전성량호.
Objective To evaluate the efficacy of destruction of dorsal root ganglia with local doxorubicin injection guided by CT for postherpetic neuralgia involving thoracic back region. Methods One hundred and fifty patients suffering from postherpetic neuralgia in thoracic back region were randomly divided into 3 groups ( n = 50 each): group A oral medicine; B and C groups undergoing local injection under the guidance of C-arm and CT respectively + oral medicine. Three spinal segments severely affected by herpes virus were chosen for paravertebral puncture. 1% lidocaine 1 ml was injected at each segment as test dose. Fifteen minutes later doxorubicin 3.3 mg and betamethasone compound 4.7 mg were injected at each segment if no side-effect occurred. All 3 groups were given oral medicine according to the intensity of pain after local injection. The number of patients who exited from the study because of the side effects of oral medicine was recorded. VAS, sleep interference score (SIS) and a short form of McGill pain questionnaire (SF-MPQ) were used to evaluate the efficacy of the treatment the day before (baseline), 24 h, 1 week, 1, 3 and 6 months after local injection. The dosage of oxycodone extended-release tablets and gabapentin was recorded, and also the incidence of pneumothorax within 12 h after local injection. Results The exit rate, VAS, SIS and SF-MPQ scores, dosage of oxycodone extended-release tablet and gabapentin were significantly lower in B and C groups than in group A, but there was no significant difference between the 2 groups. The incidence of pneumothorax was 10% in group B but no pneumothorax developed in group C.Conclusion Destruction of dorsal root ganglia with local doxorubicin injection guided by CT is more effective for the treatment of postherpetic neuralgia.