| [Objective]Acute herpes zoster(AHZ)is a common clinical disease characterized by skin damage caused by virus infection.Due to the nerve damage caused by virus,patients often develop refractory neuropathic pain,and eventually develop into postherpetic neuralgia(PHN),which brings difficulties to clinical treatment.Currently,antiviral drugs and glucocorticoids are the most commonly used oral drug therapy,supplemented by neurotrophic drugs.However,based on oral drugs,there is no clinical comparative study on glucocorticoids for nerve block injection in patients with AHZ.This study was designed to observe the effects of two different treatments on the AHZ Mc Gill pain questionnaire,sleep disturbance score,subjective treatment effect,inflammatory factors,lymphocyte subsets and long-term PHN incidence rate,so as to provide certain clinical data support for the use of oral nerve block combined with nerve block,so as to better evaluate its clinical application value.[Method](1)Data collection: from April 2019 to January 2020,70 patients with acute herpes zoster on the chest and back were selected from the pain clinic of Shanghai Songjiang District Central Hospital.All patients completed blood routine examination,ESR,liver and kidney function examination,and all patients should meet the inclusion and exclusion criteria for clinical observation.General information such as gender,age and course of disease were collected.(2)Experimental grouping: all the patients were randomly divided into oral drug group(group A,n=30)and triamcinolone acetonide paravertebral nerve block group(group T,n=40).Group A was treated with gabapentin + Mecobalamin + acyclovir +tramadol.In group T,the same drugs as group A were taken orally and combined with triamcinolone acetonide for the treatment of paravertebral nerve block.Injections include local anesthetics,glucocorticoids,vitamin B12.And the specific nerve block segment was determined according to the skin lesions of patients.(3)Subjective score: the short form Mc Gill Pain Questionnaire score,sleep disturbance score,subjective treatment effect and other subjective scores were collected before and 4 weeks after treatment.(4)Lymphocyte and inflammatory factors: the elbow vein blood of the two groups were collected before and 4 weeks after treatment,and the CD4 + T cells,CD8 + T cells,CD4 + T/CD8 + T ratio were detected by flow cytometry.The plasma levels of TNF-α,IL-1β,neuron specific enolase(NSE)and S100 β protein were detected by ELISA.(5)Observe and record the number of adverse drug reactions such as dizziness,drowsiness and skin edema in the whole course of treatment.[Results](1)In this study,70 patients were successfully completed the treatment process,and were able to cooperate with the completion of all subjective scores and laboratory tests.No adverse reactions were found during the treatment.(2)There was no statistically significant difference in general information such as gender,age,and disease course between the two groups(p>0.05).(3)After treatment,the scores of short Mc Gill Pain Questionnaire,sleep disturbance and subjective treatment effect of the two groups were significantly improved(p<0.05).The scores of short Mc Gill Pain Questionnaire and sleep disturbance of group T were significantly lower than those of group A(p<0.05).In terms of subjective treatment effects,group T is also significantly better than group A(p<0.05).(4)The levels of TNF-α,IL-1β,NSE and S100 β in the two groups after treatment were lower than those before treatment(p<0.05).The CD4+T ratio and CD4+/CD8+ ratio of the two groups of patients after treatment were significantly higher than before treatment(p<0.05),and the CD8+T ratio was significantly lower than before treatment(p<0.05).In addition,after treatment,the CD8+T ratio in group T was significantly lower than that in group A(p<0.01),and the ratio of CD4+/CD8+was significantly higher than that in group A(p<0.01).(5)The adverse reaction symptoms of patients in two groups were mild.The patients in group T had dizziness,drowsiness,and skin edema in 2,3,and 2,respectively,and in group A,1,2,and 1,respectively.There is no statistically significant difference between two groups(p>0.05).[Conclusion](1)On the basis of oral drugs,combined with paravertebral nerve block therapy can improve the subjective scores of AHZ patients,such as SF-MPQ,SIS,and treatment effectiveness,better than oral drug therapy alone.(2)On the basis of oral drugs,combined paravertebral nerve block therapy can improve the CD8+T ratio and CD4+/CD8+ ratio of AHZ patients better than oral drug therapy alone.(3)On the basis of oral drugs,combined paravertebral nerve block therapy can improve the inflammatory factors such as TNF-α,IL-1β,NSE,and S100β in patients with AHZ better than oral drug therapy alone.(4)The combined treatment of AHZ with paravertebral nerve block based on oral drugs is better than simple oral drugs in improving patient subjective scores,suppressing acute inflammation,and restoring immune function,and can be used as one of the first clinical treatments.(5)Triamcinolone acetonide was used for nerve block in the treatment of AHZ.No serious adverse reactions were found in the patient,and the treatment was relatively safe. |
PDF Full Text Request