CAJ | 학술논문

目的评价超声引导后路肋间神经阻滞对带状疱疹性神经痛患者的疗效.方法拟行后路肋间神经阻滞的胸背部带状疱疹性神经痛患者48例,性别不限,年龄56～84岁,体重48～83 kg病程＜30 d.后路肋间神经阻滞用药:0.75%罗哌卡因10ml+确炎舒松A 20 mg+2%亚甲蓝2ml,用0.9%生理盐水配制成20ml.采用便携超声仪和高频直线探头(6～13 MHz)或腹部扇形探头(2～5 MHz),采用超声引导长轴平面内技术,穿刺针尖到达胸膜外,近肋骨下阴影区域时,回吸注射器无回血后,根据带状疱疹分布阻滞肋间神经,每束肋间神经注射镇痛药3ml.于治疗前、治疗后1、2、4和8周采用VAS评分法评价疼痛程度,计算疼痛缓解度,采用生活质量评分法评价生活质量;于治疗后8周进行镇痛疗效分级,计算治疗有效率和显效率,记录并发症的发生情况.结果操作过程中均未发生穿刺针误穿胸膜,阻滞后患者均未发生胸闷或呼吸困难.治疗后各时点VAS评分降低,生活质量升高,疼痛缓解度逐渐升高(P＜0.05或0.01).治疗后8周有效率96%,显效率83%.结论超声引导后路肋间神经阻滞对带状疱疹性神经痛患者的疗效确切,不良反应少,改善了生活质量.
목적 평개초성인도후로륵간신경조체대대상포진성신경통환자적료효.방법 의행후로륵간신경조체적흉배부대상포진성신경통환자48례,성별불한,년령56～84세,체중48～83 kg병정＜30 d.후로륵간신경조체용약:0.75%라고잡인10ml+학염서송A 20 mg+2%아갑람2ml,용0.9%생리염수배제성20ml.채용편휴초성의화고빈직선탐두(6～13 MHz)혹복부선형탐두(2～5 MHz),채용초성인도장축평면내기술,천자침첨도체흉막외,근륵골하음영구역시,회흡주사기무회혈후,근거대상포진분포조체륵간신경,매속륵간신경주사진통약3ml.우치료전、치료후1、2、4화8주채용VAS평분법평개동통정도,계산동통완해도,채용생활질량평분법평개생활질량;우치료후8주진행진통료효분급,계산치료유효솔화현효솔,기록병발증적발생정황.결과 조작과정중균미발생천자침오천흉막,조체후환자균미발생흉민혹호흡곤난.치료후각시점VAS평분강저,생활질량승고,동통완해도축점승고(P＜0.05혹0.01).치료후8주유효솔96%,현효솔83%.결론 초성인도후로륵간신경조체대대상포진성신경통환자적료효학절,불량반응소,개선료생활질량.
Objective To evaluate ultrasound-guided posterior approach to intercostal block for herpetic neuralgia. Methods Forty-eight patients with herpetic neuralgia after appearance of rashes on the back of chest (the coursc ＜ 30 days) aged 56-84 yr received intercostal block performed via posterior approach under the guidance of ultrasound with a mixture of 0.75% ropivacaine, glucocorticoid and methylene blue. Pain was assessed with visual analogue scale (VAS) before block and at 1, 2, 4 and 8 weeks after block. Pain relief (PAR) was cal-culated (PAR= (VAS score before block- VAS score after block) ÷ VAS score before block × 100%). Results No patient developed dyspnea and pneumothorax. VAS scores were reduced significantly, quality of life was improved and PAR increased at 1, 2, 4 ancl 8 weeks after block ( P ＜ 0.05 or 0.01). Concluslon Ultracound-guided posterior approach to intercostal block is safe and effective for the treatment of herpetic neuralgia.