摘要
带状疱疹相关性疼痛(zoster-associated pain,ZAP)是由水痘-带状疱疹病毒再激活引发的神经病理性疼痛综合征,依据病程可分为急性期带状疱疹神经痛(acute herpetic neuralgia,AHN)、亚急性期带状疱疹神经痛(subacute herpetic neuralgia,SHN)及后遗期的带状疱疹后神经痛(postherpetic neuralgia,PHN)3个阶段。其中PHN是临床最常见且治疗难度最大的并发症,以疼痛剧烈、病程持久为典型特征,易诱发焦虑、抑郁等情绪障碍,在老年及免疫功能缺陷人群中发生率显著升高。西医治疗以早期抗病毒、抗炎、营养神经及阶梯化镇痛为核心原则,对于顽固性疼痛,推荐采用神经阻滞、脊髓电刺激等微创介入治疗方案。中医将带状疱疹归属于“蛇串疮”范畴,强调分期论治:急性期以清肝胆湿热为主,亚急性期侧重健脾祛湿,后遗期核心为益气活血,同时配合针灸、火针、艾灸等外治法疏通经络、缓解疼痛。临床实践证实,中西医结合全程管理具有显著优势:急性期采用抗病毒药物联合中医清热解毒疗法,可显著降低PHN的发生率;对于已发生PHN的患者,中药活血化瘀疗法联合西医镇痛及微创治疗,能有效改善患者预后。此外,针对老年及免疫力低下患者,需重视营养支持、心理干预等综合措施。未来仍需进一步探索中西医协同作用机制,优化治疗方案,从而提升临床诊疗效果。
Zoster-associated pain(ZAP)is a neuropathic pain syndrome caused by the reactivation of the varicella-zoster virus.Based on disease course,it can be classified into three stages:acute herpetic neuralgia(AHN),subacute herpetic neuralgia(SHN),and postherpetic neuralgia(PHN).Among these,PHN is the most common and the most difficult complication to treat,characterized by severe pain and prolonged duration,often leading to emotional disorders such as anxiety and depression.Its incidence is significantly higher in elderly individuals and immunocompromised patients.Western medicine management is centered on early antiviral therapy,anti-inflammatory treatment,neurotrophic support,and stepwise analgesia.For refractory pain,minimally invasive interventional approaches such as nerve block and spinal cord stimulation are recommended.In traditional Chinese medicine(TCM),this condition falls under category of“snake-string sores”(she chuan chuang).Treatment emphasizes stage-based differentiation:In the acute stage,the focus is on clearing damp-heat from the liver and gallbladder;in the subacute stage,strengthening the spleen and eliminating dampness;and in the chronic stage,tonifying qi and promoting blood circulation.These are combined with external therapies such as acupuncture,fire needle therapy,and moxibustion to unblock meridians and relieve pain.Clinical practice has demonstrated that whole-course management integrating TCM and Western medicine has significant advantages.In the acute stage,combining antiviral drugs with TCM heatclearing and detoxifying therapies can significantly reduce the incidence of PHN.For patients with established PHN,combining TCM therapies that promote blood circulation and remove stasis with Western analgesics and minimally invasive interventions can effectively improve prognosis.Additionally,for elderly and immunocompromised patients,comprehensive measures such as nutritional support and psychological intervention are essential.Further research is needed to elucidate the synergistic mechanisms between TCM and Western medicine and to optimize treatment strategies,thereby improving clinical outcomes.
作者
单汉民
苗晋玲
郭雪娇
丁露
耿武军
冯智英
SHAN Hanmin;MIAO Jinling;GUO Xuejiao;DING Lu;GENG Wujun;FENG Zhiying(Department of Pain Medicine,First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003;Department of Pain Medicine,Zhejiang Hospital,Hangzhou 310030;Department of Acupuncture and Moxibustion,Shanxi Hospital of Acupuncture and Moxibustion,Taiyuan 030006;Department of Pain Medicine,First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)
出处
《中南大学学报(医学版)》
北大核心
2026年第1期44-52,共9页
Journal of Central South University (Medical Science)
基金
国家卫生健康委员会科学研究基金——浙江省卫生健康重大科技计划项目(WKJ-ZJ-2404)。
