Effect of intradermal injection of compound betamethasone in pain area on post-herpetic neuralgia in thoracic and dorsal regions
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摘要:目的 探讨复方倍他米松疼痛区域皮内注射对胸背部带状疱疹后遗神经痛的效果。方法 前瞻性研究140例胸背部带状疱疹合并后遗性神经痛患者的诊疗情况，将所选患者随机分为对照组与观察组，各70例。对照组实施皮内注射地塞米松+神经阻滞，并给予加巴喷丁口服治疗; 观察组实施皮内注射复方倍他米松+神经阻滞，并给予加巴喷丁口服治疗。2组患者均治疗8周。2组患者于首次皮内注射后应用曲马多缓释片治疗(100 mg), 每12 h服1次，根据疼痛情况调整用药，最长服用1周后停止。观察并比较2组患者的疗效、治疗前后视觉模拟评分法(VAS)评分、曲马多缓释片用药量、治疗前后睡眠质量(QS)评分及不良反应情况。结果 观察组患者的治疗总有效率(98.57%)显著优于对照组(75.71%) (P < 0.05); 2组患者治疗前的VAS评分差异无统计学意义(P>0.05); 治疗后, 2组患者的VAS评分均较治疗前显著降低，且观察组评分显著低于对照组(P < 0.05); 观察组的曲马多缓释片用药量为(698.50±96.50) mg, 显著低于对照组的(1 289.50±169.50) mg(P < 0.05); 2组患者不良反应情况差异无统计学意义(P>0.05)。结论 采用复方倍他米松疼痛区域皮内注射治疗胸背部带状疱疹后遗神经痛的患者，其治疗效果优于应用地塞米松的患者。Abstract:Objective To investigate the effect of intradermal injection of compound betamethasone in pain area on post-herpetic neuralgia in thoracic and dorsal regions.Methods A prospective study was conducted for 140 herpes zoster cases with post-herpetic neuralgia treated in our hospital. The included patients were randomly divided into control group(n=70) and observation group(n=70). The control group received intradermal injection of dexamethasone plus nerve block, as well as oral administration of gabapentin, while the observation group was given intradermal injection of compound betamethasone plus nerve block, and oral administration of gabapentin. The treatment of both groups lasted for 8 weeks. After the first intradermal injection, tramadol sustained-release tablets (100 mg) were administered every 12 hours for patients in both groups, and dosages of medicine was adjusted according to the pain condition, and the longest administration course was one week. The therapeutic effect, Visual Analogue Scale (VAS) scores before and after treatment, the dosage of tramadol sustained-release tablets, the quality of sleep (QS) score before and after treatment and the adverse reactions were observed and compared between the two groups.Results The total effective rate of the observation group was significantly better than that of the control group (98.57% vs. 75.71%, P < 0.05). The VAS scores between the two groups before treatment showed no significant difference(P>0.05), it was significantly declined after treatment than before treatment in two groups, and the observation group was significantly lower than that of the control group (P < 0.05). The dosage of tramadol sustained-release tabletsin the observation group was significantly lower than that in the control group [(698.50±96.50) mg vs. (1 289.50±169.50) mg, P < 0.05]. There were no significant differences in adverse reactions between the two groups (P>0.05).Conclusion Patients with intradermal injection of compound betamethasone in pain area have more significant efficacy than those with dexamethasone in the treatment of post-herpetic neuralgia in thoracic and dorsal regions.
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表 1 2组患者疗效比较[n(%)]
组别 n 治愈 显效 有效 无效 总有效 对照组 70 14(20.00) 14(20.00) 25(35.71) 17(24.29) 53(75.71) 观察组 70 35(50.00) 23(32.86) 11(15.71) 1(1.43) 69(98.57)* 与对照组比较, *P < 0.05。 
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表 2 2组患者治疗前、后VAS评分比较(x±s)
分 组别 n 治疗前 治疗后 1周 2周 4周 6周 8周 对照组 70 8.45±0.60 6.45±0.70* 4.28±0.68* 3.85±0.58* 2.98±0.70* 1.27±0.48* 观察组 70 8.55±0.35 5.18±0.25*# 3.48±0.35*# 2.00±0.28*# 1.13±0.24*# 0.49±0.19*# 与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 3 2组患者治疗前、后QS评分情况(x±s)
分 组别 n 治疗前 治疗后 1周 2周 4周 6周 8周 对照组 70 3.71±0.31 3.34±0.45* 2.35±0.25* 1.97±0.30* 1.72±0.45* 1.14±0.42* 观察组 70 3.73±0.29 2.15±0.21*# 1.13±0.14*# 0.69±0.15*# 0.42±0.13*# 0.21±0.12*# 与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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