摘要
目的探究加巴喷丁联合星状神经节阻滞治疗带状疱疹后三叉神经痛(trigeminal postherpetic neuralgia,TG-PHN)患者的疗效及对疼痛、应激指标及睡眠质量的影响。方法选择2021年3月至2024年3月西安交通大学第一附属医院疼痛科收治的TG-PHN患者90例为研究对象,用抛硬币法分为观察组和对照组,每组45例。对照组为常规治疗+加巴喷丁疼痛区域局部注药治疗,观察组为常规治疗+加巴喷丁气管旁入路星状神经节阻滞治疗。采用视觉模拟评分法(VAS)评估两组患者疼痛程度,匹兹堡睡眠质量指数(PSQI)评估两组患者睡眠质量,ELISA法检测两组患者血清应激指标[去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)]及血清生化指标[P物质(SP)、β内啡肽(β-EP)、降钙素基因相关肽(CGRP)、趋化因子配体10(CXCL-10)、神经激肽1(NK-1)]。治疗期间,记录两组患者不良反应发生情况。结果治疗后,观察组患者总有效率高于对照组[93.33%(42/45)vs 77.78%(35/45);χ^(2)=4.406,P=0.036]。治疗后,两组患者VAS、PSQI评分及NE、E、Cor、SP、CGRP、CXCL-10、NK-1水平均低于治疗前,β-EP水平均高于治疗前(对照组:t=10.813、13.617、3.410、9.773、9.912、11.262、16.362、9.767、16.616、6.364,均P<0.05;观察组:t=15.868、14.473、14.492、15.151、16.649、24.022、26.814、12.836、16.452、11.512,均P<0.05)。治疗后观察组患者VAS、PSQI评分[(4.79±1.29)分vs(3.81±1.12)分、(9.23±1.66)分vs(8.41±2.10)分,t=3.848、2.055,均P<0.05]及NE、E、Cor、SP、CGRP、CXCL-10、NK-1水平均低于对照组(t=11.869、7.217、14.123、10.220、19.484、2.568、3.184,均P<0.05),β-EP水平高于对照组[(20.20±3.00)pg/mL vs(26.01±4.98)pg/mL,t=6.704,P<0.05]。治疗期间,两组患者不良反应发生率比较差异无统计学意义(χ^(2)=0.385,P=0.535)。结论加巴喷丁联合星状神经节阻滞治疗TG-PHN能有效缓解患者疼痛症状,提升睡眠质量,减轻应激反应。
Objective To explore the efficacy of gabapentin combined with stellate ganglion block in the treatment of patients with trigeminal postherpetic neuralgia(TG-PHN)and its influence on pain,stress indicators and sleep quality.Methods A total of 90 patients with TG-PHN treated in the Department of Pain of the First Affiliated Hospital of Xi’an Jiaotong University from March 2021 to March 2024 were recruited as the research subjects and randomly divided into the observation group(45 cases)and the control group(45 cases)by the coin tossing method.The control group was treated with gabapentin combined with local injection of pain area,while the observation group received gabapentin combined with stellate ganglion block therapy.Visual analogue scale(VAS)was used to evaluate the pain degree in the two groups,and Pittsburgh Sleep Quality Index(PSQI)was adopted to assess the sleep quality of the two groups.Serum stress indicators(norepinephrine(NE),epinephrine(E),cortisol(Cor))and serum biochemical indicators(substance P(SP),β-endorphin(β-EP),calcitonin gene-related peptide(CGRP),chemokine ligand 10(CXCL-10),and neurokinin-1(NK-1))were detected for the two groups by ELISA.The adverse reactions of the two groups were recorded during treatment.Results The total effective rate of the observation group was higher than that of the control group after the treatment(93.33%(42/45)vs 77.78%(35/45))(χ^(2)=4.406,P=0.036).The scores of VAS and PSQI and the levels of NE,E,Cor,SP,CGRP,CXCL-10 and NK-1 of the two groups were lower after the treatment than those before the treatment,while theβ-EP level was lower after the treatment than that before the treatment(the control group:t=10.813,13.617,3.410,9.773,9.912,11.262,16.362,9.767,16.616,6.364,all P<0.05;the observation group:t=15.868,14.473,14.492,15.151,16.649,24.022,26.814,12.836,16.452,11.512,all P<0.05).The scores of VAS and PSQI((4.79±1.29)points vs(3.81±1.12)points,(9.23±1.66)points vs(8.41±2.10)points,t=3.848,2.055,both P<0.05)and the levels of NE,E,Cor,SP,CGRP,CXCL-10 and NK-1(t=11.869,7.217,14.123,10.220,19.484,2.568,3.184,all P<0.05)were lower in the observation group than those in the control group after the treatment,while theβ-EP level was higher in the observation group than that in the control group((20.20±3.00)pg/mL vs(26.01±4.98)pg/mL,t=6.704,P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups during the treatment(χ^(2)=0.385,P=0.535).Conclusion Gabapentin combined with stellate ganglion block in the treatment of TG-PHN can effectively relieve pain symptoms,enhance sleep quality and reduce stress response.
作者
闫芍药
聂会勇
原伟莉
王锁良
张佳
YAN Shaoyao;NIE Huiyong;YUAN Weili;WANG Suoliang;ZHANG Jia(Department of Pain,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)
出处
《中国药物应用与监测》
2025年第9期1555-1559,共5页
Chinese Journal of Drug Application and Monitoring
基金
陕西省重点研发计划项目(S2021-YF-YBSF-0481)。
