穴位注射配合药物治疗带状疱疹后遗神经痛的临床研究
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摘要
目的观察穴位注射配合药物治疗带状疱疹后遗神经痛的临床疗效。方法将64例带状疱疹后遗神经痛患者随机分为治疗组和对照组,每组32例。治疗组采用夹脊穴注射丹参注射液配合口服加巴喷丁片治疗,对照组采用单纯口服加巴喷丁片治疗。两组如疼痛严重可加服盐酸曲马多缓释片治疗。观察两组治疗前后视觉模拟评分法(visual analogue scale, VAS)评分、SF-36健康量表(the MOS 36-item short-form health survey,SF-36)各项评分的变化情况,并比较两组不同时间点服用加巴喷丁片和盐酸曲马多缓释片的剂量及各项不良反应的发生率。结果两组治疗后不同时间点(治疗1周、3周、6周、12周、24周后)VAS评分与同组治疗前比较,差异均有统计学意义(P<0.01)。治疗组治疗后不同时间点VAS评分与对照组比较,差异具有统计学意义(P<0.01)。两组治疗3周、6周、12周、24周后加巴喷丁片和盐酸曲马多缓释片的服用剂量比较,差异均具有统计学意义(P<0.05)。两组治疗12周、24周后SF-36各项评分(PF、RP、BP、GH、VT、SF、RE、MH)与同组治疗前比较,差异均具有统计学意义(P<0.05)。治疗组治疗12周、24周后SF-36中PF、RP、BP、VT、MH评分与对照组比较,差异均具有统计学意义(P<0.05)。治疗组治疗后头晕、嗜睡、恶心的发生率分别为6.7%、3.3%和3.3%,对照组分别为24.1%、17.2%和20.7%,两组比较差异均具有统计学意义(P<0.05)。结论穴位注射配合药物是一种治疗带状疱疹后遗神经痛的有效方法,能减少服用加巴喷丁片的剂量,从而减少不良反应。
Objective To observe the clinical efficacy of acupoint injection plus medication in treating postherpetic neuralgia. Method Sixty-four patients with postherpetic neuralgia were randomized into treatment and control groups,with 32 cases in each group. The treatment group was intervened by Huatuo jiaji(Ex-B2) point injection of Salvia miltiorrhiza injection plus oral administration of gabapentin tablets, while the control group was intervened by oral administration of gabapentin tablets alone. Both groups took tramadol hydrochloride sustained release tablets additionally if the pain was severe. Visual analogue scale(VAS) score and the MOS 36-item short-form health survey(SF-36) scores in the two groups were observed before and at the end of the treatment, and the dosages of gabapentin tablets and tramadol hydrochloride sustained release tablets at different time points and the incidences of adverse reactions of the two groups were compared. Result The VAS score showed a significant change after 1-week, 3-week,6-week, 12-week, 24-week treatment in the two groups(P<0.01). After 1-week, 3-week, 6-week, 12-week, 24-week treatment, the VAS score in the treatment group was significantly different from that in the control group(P<0.01).After 3-week, 6-week, 12-week, 24-week treatment, the dosages of gabapentin tablets and tramadol hydrochloride sustained release tablets in the treatment group were significantly different from those in the control group(P<0.05).The SF-36 scores [physical functioning(PF), role physical(RP), bodily pain(BP), general health(GH), vitality(VT),social functioning(SF), role emotional(RE) and mental health(MH)] showed a significant change after 12-week,24-week treatment in the two groups(P<0.05). After 12-week, 24-week treatment, the SF-36 scores(RF, RP, BP, VT and MH) in the treatment group were significantly different from those in the control group(P<0.05). The incidences of dizziness, drowsiness and nausea were respectively 6.7%, 3.3% and 3.3% in the treatment group versus 24.1%,17.2% and 20.7% in the control group, there was a statistically significant difference between the two groups(P<0.05).Conclusion Acupoint injection plus medication is an effective method in treating postherpetic neuralgia. It can reduce the dosage of gabapentin tablets, and therefore reduce adverse reactions.
Objective To observe the clinical efficacy of acupoint injection plus medication in treating postherpetic neuralgia. Method Sixty-four patients with postherpetic neuralgia were randomized into treatment and control groups,with 32 cases in each group. The treatment group was intervened by Huatuo jiaji(Ex-B2) point injection of Salvia miltiorrhiza injection plus oral administration of gabapentin tablets, while the control group was intervened by oral administration of gabapentin tablets alone. Both groups took tramadol hydrochloride sustained release tablets additionally if the pain was severe. Visual analogue scale(VAS) score and the MOS 36-item short-form health survey(SF-36) scores in the two groups were observed before and at the end of the treatment, and the dosages of gabapentin tablets and tramadol hydrochloride sustained release tablets at different time points and the incidences of adverse reactions of the two groups were compared. Result The VAS score showed a significant change after 1-week, 3-week,6-week, 12-week, 24-week treatment in the two groups(P<0.01). After 1-week, 3-week, 6-week, 12-week, 24-week treatment, the VAS score in the treatment group was significantly different from that in the control group(P<0.01).After 3-week, 6-week, 12-week, 24-week treatment, the dosages of gabapentin tablets and tramadol hydrochloride sustained release tablets in the treatment group were significantly different from those in the control group(P<0.05).The SF-36 scores [physical functioning(PF), role physical(RP), bodily pain(BP), general health(GH), vitality(VT),social functioning(SF), role emotional(RE) and mental health(MH)] showed a significant change after 12-week,24-week treatment in the two groups(P<0.05). After 12-week, 24-week treatment, the SF-36 scores(RF, RP, BP, VT and MH) in the treatment group were significantly different from those in the control group(P<0.05). The incidences of dizziness, drowsiness and nausea were respectively 6.7%, 3.3% and 3.3% in the treatment group versus 24.1%,17.2% and 20.7% in the control group, there was a statistically significant difference between the two groups(P<0.05).Conclusion Acupoint injection plus medication is an effective method in treating postherpetic neuralgia. It can reduce the dosage of gabapentin tablets, and therefore reduce adverse reactions.
引文
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[10]Klompas M,Kulldorff M,Vilk Y,et al.Herpes zoster and postherpetic neuralgia surveillance using structured electronic data[J].Mayo Clin Proc,2011,86(12):1146-1153.
[11]Avijgan M,Hajzargarbashi ST,Kamran A,et al Postherpetic Neuralgia:Practical Experiences Return to Traditional Chinese Medicine[J].J Acupunct Meridian Stud,2017,10(3):157-164.
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[13]Han JS.Acupuncture research is part of my life[J].Pain Med,2009,10(4):611-618.
[14]Serres G.Comments on the technique of the treatment of herpes zoster[J].Zhen Ci Yan Jiu,1988,13(1):6-9,5.
[15]Han JY,Fan JY,Horie Y,et al.Ameliorating effects of compounds derived from Salvia miltiorrhiza root extract on microcirculatory disturbance and target organ injury by ischemia and reperfusion[J].Pharmacol Ther,2008,117(2):280-295.
[16]Chen XY.The clinical observation of Tan combined valacyclovir hydrochloride tablets in the treatment of herpetic neuralgia[J].J Hunan Normal Univ(Med Sci),2016,3:128-130.
[17]Dworkin RH,O'Connor AB,Audette J,et al.Recommendations for the pharmacological management of neuropathic pain:an overview and literature update[J].Mayo Clin Proc,2010,85(3 Suppl):S3-14.
[18]Attal N,Cruccu G,Baron R,et al.EFNS guidelines on the pharmacological treatment of neuropathic pain:2010revision[J].Eur J Neurol,2010,17(9):1113-e88.
[19]李娟红,李桂英,程斌.夹脊穴直刺配合臭氧穴位注射治疗急性带状疱疹神经痛疗效观察[J].世界中西医结合杂志,2013,8(4):371-374.
[20]付景兰,董文毅.电针艾灸治疗带状疱疹36例[J].中国针灸,2002,22(5):314.
[21]陆惠芳,马睿杰,韩德雄,等.郄穴行龙虎交战配合电针治疗带状疱疹后遗神经痛疗效观察[J].上海针灸杂志,2017,36(1):41-44.
[22]董兴辉,黄秋实,赵立刚.针刺加穴位注射夹脊穴治疗老年性带状疱疹后遗神经痛[J].针灸临床杂志,2013,29(10):20-21.
[23]鲁亦斌.针刺华佗夹脊穴加穴位注射治疗带状疱疹后遗神经痛的临床研究[D].武汉:湖北中医学院,2005:1-21.
[24]张淑杰,邹艳红.针刺夹脊穴配合围刺治疗带状疱疹后遗神经痛[J].针灸临床杂志,2009,25(2):4-6.
[25]谢衡辉,文娜.针刺补泻手法用于夹脊穴、阿是穴为主治疗带状疱疹后遗神经痛临床观察[J].北京中医药,2013,32(1):23-27.
[26]Xi-lang N.Treatment of 48 cases of herpes zoster by puncturing nerve stem[J].J Acupunct Tuina Sci,2008,6(6):368-369.
[27]刘荣芬,姜亚梅.华佗夹脊穴的针刺镇痛机理探讨[J].中国中医基础医学杂志,2008,14(12):943,947.
[28]彭丽辉,陈剑明,王颖,等.用温针灸夹脊穴法治疗腰椎间盘突出症的疗效与?-内啡肽水平相关性的分析[J].求医问药,2013,11(11):122-123.
[29]张皓,王健,陈新勇,等.电针对佐剂性关节炎大鼠镇痛作用及内啡肽影响[J].青岛大学医学院学报,2010,46(5):390-392.
[30]Ji XY,Tan BK,Zhu YZ.Salvia miltiorrhiza and ischemic diseases[J].Acta Pharmacol Sin,2000,21(12):1089-1094.
[31]Zhou L,Zuo Z,Chow MS.Danshen:an overview of its chemistry,pharmacology,pharmacokinetics,and clinical use[J].J Clin Pharmacol,2005,45(12):1345-1359.
[32]Cheng TO.Danshen:a versatile Chinese herbal drug for the treatment of coronary heart disease[J].Int J Cardiol,2006,113(3):437-438.
[33]Lam BY,Lo AC,Sun X,et al.Neuroprotective effects of tanshinones in transient focal cerebral ischemia in mice[J].Phytomedicine,2003,10(4):286-291.
[34]祁林,刘丽芳.丹参注射液配合体针治疗带状疱疹后遗神经痛30例临床观察[J].湖南中医药导报,2004,10(11):31-32.
[35]Shaparin N,Slattum PW,Bucior I,et al.Relationships Among Adverse Events,Disease Characteristics,and Demographics in Treatment of Postherpetic Neuralgia With Gastroretentive Gabapentin[J].Clin J Pain,2015,31(11):983-991.
[36]Meng FY,Zhang LC,Liu Y,et al.Efficacy and safety of gabapentin for treatment of postherpetic neuralgia:a meta-analysis of randomized controlled trials[J].Minerva Anestesiol,2014,80(5):556-567.
[37]Wang J,Zhu Y.Different doses of gabapentin formulations for postherpetic neuralgia:A systematical review and meta-analysis of randomized controlled trials[J].JDermatolog Treat,2017,28(1):65-77.
[2]Buono N,Thulesius H,Petrazzuoli F,et al.Postherpetic neuralgia,diabetic neuropathy,and trigeminal neuralgiaChronic peripheral neuropathic pain in 58,480 rural Italian primary care patients[J].J Family Med Prim Care2017,6(1):110-114.
[3]Park SK,Choi YS.Treatment Option for Refractory Postherpetic Neuralgia-Transversus Abdominis Plane(TAP)Block:Two Case Reports[J].Anesth Pain Med2016,7(1):e41378.
[4]Drolet M,Brisson M,Schmader KE,et al.The impact of herpes zoster and postherpetic neuralgia on health-related quality of life:a prospective study[J].CMAJ,2010,182(16):1731-1736.
[5]Pickering G,Leplege A.Herpes zoster pain,postherpetic neuralgia,and quality of life in the elderly[J].Pain Pract2011,11(4):397-402.
[6]Forbes HJ,Thomas SL,Smeeth L,et al.A systematic review and meta-analysis of risk factors for postherpetic neuralgia[J].Pain,2016,157(1):30-54.
[7]Massengill JS,Kittredge JL.Practical considerations in the pharmacological treatment of postherpetic neuralgia for the primary care provider[J].J Pain Res,2014,7:125-132.
[8]Friesen KJ,Chateau D,Falk J,et al.Cost of shingles:population based burden of disease analysis of herpes zoster and postherpetic neuralgia[J].BMC Infect Dis2017,17(1):69.
[9]Sacks GM.Unmet need in the treatment of postherpetic neuralgia[J].Am J Manag Care,2013,19(1 Suppl):S207-213.
[10]Klompas M,Kulldorff M,Vilk Y,et al.Herpes zoster and postherpetic neuralgia surveillance using structured electronic data[J].Mayo Clin Proc,2011,86(12):1146-1153.
[11]Avijgan M,Hajzargarbashi ST,Kamran A,et al Postherpetic Neuralgia:Practical Experiences Return to Traditional Chinese Medicine[J].J Acupunct Meridian Stud,2017,10(3):157-164.
[12]Tang JL,Liu BY,Ma KW.Traditional Chinese medicine[J].Lancet,2008,372(9654):1938-1940.
[13]Han JS.Acupuncture research is part of my life[J].Pain Med,2009,10(4):611-618.
[14]Serres G.Comments on the technique of the treatment of herpes zoster[J].Zhen Ci Yan Jiu,1988,13(1):6-9,5.
[15]Han JY,Fan JY,Horie Y,et al.Ameliorating effects of compounds derived from Salvia miltiorrhiza root extract on microcirculatory disturbance and target organ injury by ischemia and reperfusion[J].Pharmacol Ther,2008,117(2):280-295.
[16]Chen XY.The clinical observation of Tan combined valacyclovir hydrochloride tablets in the treatment of herpetic neuralgia[J].J Hunan Normal Univ(Med Sci),2016,3:128-130.
[17]Dworkin RH,O'Connor AB,Audette J,et al.Recommendations for the pharmacological management of neuropathic pain:an overview and literature update[J].Mayo Clin Proc,2010,85(3 Suppl):S3-14.
[18]Attal N,Cruccu G,Baron R,et al.EFNS guidelines on the pharmacological treatment of neuropathic pain:2010revision[J].Eur J Neurol,2010,17(9):1113-e88.
[19]李娟红,李桂英,程斌.夹脊穴直刺配合臭氧穴位注射治疗急性带状疱疹神经痛疗效观察[J].世界中西医结合杂志,2013,8(4):371-374.
[20]付景兰,董文毅.电针艾灸治疗带状疱疹36例[J].中国针灸,2002,22(5):314.
[21]陆惠芳,马睿杰,韩德雄,等.郄穴行龙虎交战配合电针治疗带状疱疹后遗神经痛疗效观察[J].上海针灸杂志,2017,36(1):41-44.
[22]董兴辉,黄秋实,赵立刚.针刺加穴位注射夹脊穴治疗老年性带状疱疹后遗神经痛[J].针灸临床杂志,2013,29(10):20-21.
[23]鲁亦斌.针刺华佗夹脊穴加穴位注射治疗带状疱疹后遗神经痛的临床研究[D].武汉:湖北中医学院,2005:1-21.
[24]张淑杰,邹艳红.针刺夹脊穴配合围刺治疗带状疱疹后遗神经痛[J].针灸临床杂志,2009,25(2):4-6.
[25]谢衡辉,文娜.针刺补泻手法用于夹脊穴、阿是穴为主治疗带状疱疹后遗神经痛临床观察[J].北京中医药,2013,32(1):23-27.
[26]Xi-lang N.Treatment of 48 cases of herpes zoster by puncturing nerve stem[J].J Acupunct Tuina Sci,2008,6(6):368-369.
[27]刘荣芬,姜亚梅.华佗夹脊穴的针刺镇痛机理探讨[J].中国中医基础医学杂志,2008,14(12):943,947.
[28]彭丽辉,陈剑明,王颖,等.用温针灸夹脊穴法治疗腰椎间盘突出症的疗效与?-内啡肽水平相关性的分析[J].求医问药,2013,11(11):122-123.
[29]张皓,王健,陈新勇,等.电针对佐剂性关节炎大鼠镇痛作用及内啡肽影响[J].青岛大学医学院学报,2010,46(5):390-392.
[30]Ji XY,Tan BK,Zhu YZ.Salvia miltiorrhiza and ischemic diseases[J].Acta Pharmacol Sin,2000,21(12):1089-1094.
[31]Zhou L,Zuo Z,Chow MS.Danshen:an overview of its chemistry,pharmacology,pharmacokinetics,and clinical use[J].J Clin Pharmacol,2005,45(12):1345-1359.
[32]Cheng TO.Danshen:a versatile Chinese herbal drug for the treatment of coronary heart disease[J].Int J Cardiol,2006,113(3):437-438.
[33]Lam BY,Lo AC,Sun X,et al.Neuroprotective effects of tanshinones in transient focal cerebral ischemia in mice[J].Phytomedicine,2003,10(4):286-291.
[34]祁林,刘丽芳.丹参注射液配合体针治疗带状疱疹后遗神经痛30例临床观察[J].湖南中医药导报,2004,10(11):31-32.
[35]Shaparin N,Slattum PW,Bucior I,et al.Relationships Among Adverse Events,Disease Characteristics,and Demographics in Treatment of Postherpetic Neuralgia With Gastroretentive Gabapentin[J].Clin J Pain,2015,31(11):983-991.
[36]Meng FY,Zhang LC,Liu Y,et al.Efficacy and safety of gabapentin for treatment of postherpetic neuralgia:a meta-analysis of randomized controlled trials[J].Minerva Anestesiol,2014,80(5):556-567.
[37]Wang J,Zhu Y.Different doses of gabapentin formulations for postherpetic neuralgia:A systematical review and meta-analysis of randomized controlled trials[J].JDermatolog Treat,2017,28(1):65-77.