CAJ | 학술논문

目的评价硬膜外输注地塞米松-布比卡因-芬太尼混合液联合牛痘疫苗致炎兔皮提取物治疗重度带状疱疹神经痛的效果.方法带状疱疹神经痛患者48例,性别不限,年龄45-92岁,疼痛视觉模拟评分(VAS)＞ 6分,采用随机数字表法,将其随机分为2组(n=24):常规药物组(C组)与硬膜外阻滞联合牛痘疫苗致炎兔皮提取物组(T组).2组治疗期间均静脉输注牛痘疫苗致炎兔皮提取物6 ml/d,C组还口服阿米替林和加巴喷丁,T组选择带状疱疹病毒感染最严重的脊神经节段的相应椎间隙硬膜外穿刺,硬膜外输注药物配方0.075％布比卡因、芬太尼2μg/ml和地塞米松50 μg/ml,生理盐水稀释至100ml,速率2～5 ml/h,连续10d,维持VAS评分≤4分.记录硬膜外给药期间与硬膜外给药相关不良反应和带状疱疹后神经痛的发生情况.结果与C组比较,T组尿潴留和带状疱疹后神经痛的发生率降低(p＜0.05或0.01).T组未见其他不良反应.结论硬膜外输注地塞米松-布比卡因-芬太尼混合液联合牛痘疫苗致炎兔皮提取物可有效地缓解严重带状疱疹神经痛,预防带状疱疹后神经痛的发生,且安全性良好.
목적 평개경막외수주지새미송-포비잡인-분태니혼합액연합우두역묘치염토피제취물치료중도대상포진신경통적효과.방법 대상포진신경통환자48례,성별불한,년령45-92세,동통시각모의평분(VAS)＞ 6분,채용수궤수자표법,장기수궤분위2조(n=24):상규약물조(C조)여경막외조체연합우두역묘치염토피제취물조(T조).2조치료기간균정맥수주우두역묘치염토피제취물6 ml/d,C조환구복아미체림화가파분정,T조선택대상포진병독감염최엄중적척신경절단적상응추간극경막외천자,경막외수주약물배방0.075％포비잡인、분태니2μg/ml화지새미송50 μg/ml,생리염수희석지100ml,속솔2～5 ml/h,련속10d,유지VAS평분≤4분.기록경막외급약기간여경막외급약상관불량반응화대상포진후신경통적발생정황.결과 여C조비교,T조뇨저류화대상포진후신경통적발생솔강저(p＜0.05혹0.01).T조미견기타불량반응.결론 경막외수주지새미송-포비잡인-분태니혼합액연합우두역묘치염토피제취물가유효지완해엄중대상포진신경통,예방대상포진후신경통적발생,차안전성량호.
Objective To evaluate the efficacy of epidural infusion of a mixture of bupivacaine-fentanyl-dexamethasone on top of intravenous extract from rabbit skin inflamed by vaccinia virus (ERSVV) for severe herpetic neuralgia.Methods Forty-eight patients of both sexes with severe herpetic neuralgia aged 45-92 yr were randomly divided into 2 groups (n =24 each):control group (group C) and test group( group T).Both groups received intravenous ERSVV 6 ml/d.Group C received oral amitriptyline and gabapentin,while the group T received epidural infusion of 100 ml of a mixture of 0.075％ bupivacaine,fentanyl 2 μg/ml and dexamethasone 50 μg/ml in normal saline at 2-5 ml/h,once a day for 10 days and VAS score was maintained≤4.Epidural puncture was performed at the spinal segments severely affected by herpes virus.Intensity of pain was assessed with VAS (0 =no pain,10 =worst pain).In group C when VAS ＞ 4 oral amitriptyline 12.5 mg (once/d) and gabapenti 0.1 g (3 times/d) were given as rescue analgesics.Adverse effects of epidural infusion and incidence of post-herpetic neuralgia were recorded.Results The incidence of urinary retention and incidence of post-herpetic neuralgia were lower in group T than in group C.No other adverse effects were found in group T.Conclusion Epidural infusion of a mixture of bupivacaine-fentanyl-dexamethasone on top of ERSVV can effectively reduce severe herpetic neuralgia and prevent development of post-herpetic neuralgia safely.