CAJ | 학술논문

目的：观察复方利多卡因乳膏联合芬太尼透皮贴剂治疗带状疱疹后遗神经痛的疗效。方法60例临床诊断为带状疱疹后遗神经痛患者随机分为三组（复方利多卡因组、芬太尼透皮贴剂组和复方利多卡因联合芬太尼透皮贴剂组），利多卡因乳膏组：在最痛的皮肤区涂抹复方利多卡因乳膏，根据皮肤大小涂抹，保留时间最大不超过12 h，每次间隔时间大于12 h，每天涂抹次数不超过3次；芬太尼透皮贴剂组：使用芬太尼初始剂量为12．5μg·h－1，如疼痛控制不满意，逐渐增加剂量（每72 h增加12．5μg·h－1）；利多卡因乳膏联合芬太尼透皮贴剂组：使用芬太尼初始剂量为12．5μg·h－1，如疼痛控制不满意，在最痛的皮肤区涂抹复方利多卡因乳膏。观察并记录治疗前三组的VAS（视觉模拟尺）评分及治疗4周后三组的VAS评分、统计三组中的芬太尼及利多卡因用量、并发症。结果三组患者疼痛均获得了明显缓解（P＜0．05），利多卡因乳膏联合芬太尼透皮贴剂组的治疗满意度与芬太尼透皮贴剂组及利多卡因乳膏组相比，有统计学差异（P＜0．05）。结论复方利多卡因乳膏联合芬太尼透皮贴剂治疗带状疱疹后遗神经痛取得了较好的疗效，值得临床推广。
목적：관찰복방리다잡인유고연합분태니투피첩제치료대상포진후유신경통적료효。방법60례림상진단위대상포진후유신경통환자수궤분위삼조（복방리다잡인조、분태니투피첩제조화복방리다잡인연합분태니투피첩제조），리다잡인유고조：재최통적피부구도말복방리다잡인유고，근거피부대소도말，보류시간최대불초과12 h，매차간격시간대우12 h，매천도말차수불초과3차；분태니투피첩제조：사용분태니초시제량위12．5μg·h－1，여동통공제불만의，축점증가제량（매72 h증가12．5μg·h－1）；리다잡인유고연합분태니투피첩제조：사용분태니초시제량위12．5μg·h－1，여동통공제불만의，재최통적피부구도말복방리다잡인유고。관찰병기록치료전삼조적VAS（시각모의척）평분급치료4주후삼조적VAS평분、통계삼조중적분태니급리다잡인용량、병발증。결과삼조환자동통균획득료명현완해（P＜0．05），리다잡인유고연합분태니투피첩제조적치료만의도여분태니투피첩제조급리다잡인유고조상비，유통계학차이（P＜0．05）。결론복방리다잡인유고연합분태니투피첩제치료대상포진후유신경통취득료교호적료효，치득림상추엄。
Objective To study the clinical efficacy of compound lidocaine cream combined with fentanyl transdermal system for the treatment of postherpetic neuralgia (PHN)in elderly patients.Methods 60 patients with PHN were randomly divided into three groups (compound lidocaine cream group,fentanyl transdermal system group and compound lidocaine cream combined with fentanyl transdermal system group).In compound lidocaine cream group,the compound lidocaine cream was applied to the skin area of maximum pain,and up to three creams were applied daily for a maximum of 12 h,with cream-free intervals of at least 12 h;in fentanyl transder-mal system group,the patients were treated with fentanyl transdermal system at the lowest available delivery rate(fentanyl dose,12.5 μg ·h-1 ),and fentanyl dose was increased by 12.5 μg·h-1 every 72 h only when the pain of patients was not controlled well;in com-pound lidocaine cream combined with fentanyl transdermal system group,the patients received the same fentanyl dose as the patients in fentanyl transdermal system group at first ,and compound lidocaine cream were applied to patients with insufficient pain relief(VAS>4).The VAS score of three groups was recorded before treatment and 4 weeks after,and dose of the lidocaine and the fentanyl of three groups were recorded,and the adverse effects were observed.Results The pain scores in three groups have decreased significantly compared to those before treatment(P<0.05);there were a significant mean reduction of fentanyl dose and lidocaine dose in compound lidocaine cream combined with fentanyl transdermal system group compared to other two groups (P<0.05).Conclusions The results suggest that the treatment of PHN using compound lidocaine cream combined with fentanyl transdermal system is a reliable method, which deserves to be used in clinical medicine widely.