加巴喷丁联合射频脉冲、神经阻滞治疗带状疱疹后神经痛的效果

摘要 目的：探讨加巴喷丁联合脉冲射频、神经阻滞治疗带状疱疹后遗神经痛的效果。方法：本研究选取106例确诊为带状疱疹后遗神经痛的患者,采用随机数表法将其分为对照组A（36例）、试验组B（35例）和试验组C（35例）。A组患者采用口服加巴喷丁进行治疗,B组患者采用加巴喷丁联合神经阻滞治疗,C组患者采用加巴喷丁联合脉冲射频治疗,观察比较三组患者的治疗效果,分别对视觉模拟评分（VAS）、夜间睡眠评分（SRSS）、疼痛程度（NRS）、不良反应及综合疗效进行统计评估。结果：治疗3天、7天、14天和1月后,与对照组A比较,B、C组患者的VAS、SRSS和NRS评分较治疗前均有显著降低（P<0.05）;试验组B、C不良反应发生率分别为8.57%（3/35）和5.71%（2/35）,对照组A不良反应发生率为22.22%（8/36）,试验组不良反应发生率显著低于对照组,差异具有统计学意义（P<0.05）。结论：相较于使用加巴喷丁和加巴喷丁联合神经阻滞这两种治疗方案,加巴喷丁联合射频脉冲及神经阻滞治疗带状疱疹后遗神经痛能够在短期内有效缓解患者疼痛并改善睡眠状况。     

加巴喷丁联合度洛西汀治疗带状疱疹后神经痛的临床观察

目的 观察加巴喷丁联合度洛西汀治疗带状疱疹后神经痛( Postherpetic neuralgia,PHN)的临床效果,为临床提供一种可行的治疗方法. 方法 将63 例PHN患者随机分为治疗组31例和对照组32例.对照组予单药服用加巴喷丁,最终计量为1800 mg/d;治疗组在服用相同计量加巴喷丁的基础上联合服用度洛西...     

带状疱疹后神经痛患者杏仁核的功能连接改变研究

带状疱疹后神经痛(postherpetic neuralgia,PHN)是一种常见的神经病理性疼痛,但其中枢机制尚不明了.杏仁核在疼痛反应中的作用近年来受到关注.本研究的目的在于通过功能磁共振成像,研究带状疱疹后神经痛患者杏仁核各个亚区功能连接(functional connectivity,FC)的改变,探索慢性神经病理性疼痛的中枢机制.8位带状疱疹后神经痛患者和8位健康者进行了普通核磁共振和静息态功能磁共振扫描.将杏仁核各个亚区分别进行的功能连接分析,并将功能连接和被试者的病程、视觉模拟评分(visual analog scale,VAS)进行了相关分析.与健康志愿者相比,PHN患者杏仁核的基底外侧部(laterobasal groups,LB)和皮质部(superficial groups,SF)与多个脑区的FC表现出增强,主要位于颞叶和额叶.同时SF与多个区域的FC出现减低,主要位于额叶和顶叶.颞叶和额叶部分区域与LB的FC强度、与病程长短和VAS评分表现出关联性.研究结果提示,PHN患者杏仁核功能连接的改变提示了在慢性神经病理性疼痛的产生和发展中,杏仁核以及多个涉及情绪、认知、注意的脑区发挥了重要作用.     

半导体激光治疗带状疱疹后遗神经痛1例

1病例介绍患者,男,41岁,患右胸部带状疱疹。经药物治疗1周后,疱疹结痂脱落,但右胸部、右后背部仍呈刀割样放射性疼痛,并持续反复发作,衣服摩擦及阴雨天疼痛加重,夜间尤其明显,严重影响活动、睡眠而来我院治疗。入院后给予MDC-500型半导体激光照射治疗：（1）神经根照射。激光光斑对准相应神经根或神经节处照射,功率300-350mW,每点3～5min,每日1次。（2）穴位照射。主要选穴：背部相应的华佗夹脊穴、心俞、督俞、膈俞、中庭、膻中、日月,每次选用3～4个主穴,1～2个阿是穴,每个穴位照射3～5min,每日1次,照射功率为300mW。7次为1个疗程,共治疗2个疗程,疗程间休息4天。经过1个疗程治疗后疼痛明显减轻,2个疗程后疼痛完全消失．     

普瑞巴林、加巴喷丁联合神经阻滞治疗带状疱疹后神经痛的临床疗效比较

目的:比较普瑞巴林、加巴喷丁联合神经阻滞治疗带状疱疹后神经痛(PHN)的临床疗效。方法:选择2014年8月至2016年11月我院门诊收治的带状疱疹后神经痛患者80例,并将其随机分为两组,每组40例。A组患者接受普瑞巴林联合神经阻滞治疗,B组患者接受加巴喷丁联合神经阻滞治疗,比较两组患者治疗前后的视觉疼痛模拟(VAS)评分、失眠严重程度指数(ISI)评分、生活质量满意指数(LSIB)评分及治疗期间不良反应的发生情况。结果:A组患者治疗后4、7、14 d的VAS评分均显著低于B组(P0.05),LSIB评分显著高于B组(P0.05),A组患者治疗后4、7 d的ISI评分均显著低于B组(P0.05);A组发生不良反应的总发生率显著低于B组(P0.05)。结论:普瑞巴林联合神经阻滞治疗PHN缓解疼痛和失眠的效果显著优于巴喷丁联合神经阻滞治疗,其可显著提高患者的生活质量,并减少不良反应。     

带状疱疹后遗神经痛的动物模型及病理机制研究

带状疱疹后遗神经痛(postherpetic neuralgia,PHN)是带状疱疹最常见的并发症,其发生率随年龄的增加而增加,并且严重影响患者的生活质量。目前PHN的治疗多采用复合用药,但效果不佳。阻碍其治疗发展的关键是对PHN的发病机制不甚清楚,究其根本原因是缺乏与临床符合的动物模型。目的:综述带状疱疹病毒感染模型的改良和进展,使PHN的病理机制得到进一步揭示。内容:介绍与PHN相关的水痘-带状疱疹病毒潜伏感染模型、体外模型及慢性感染模型,综述与PHN发生发展有关的潜伏机制、与其他神经病理性痛相似的机制及近年来较为关注的中枢与外周损伤机制。趋向:进一步研究与人类水痘带状疱疹病毒感染更为相似的动物模型,并随其改良和进展,使发生PHN的机制得到进一步的阐释。     

He—Ne激光治疗带状疱疹神经痛

４３例带状疱疹病人随机分为Ｈｅ－Ｎｅ激光治疗组（２９例）及红外线对照组（１４例）,分别进行局部治疗（两组全身用药相同）。采用“６点行为疼痛测定法”对治疗期及治疗完成时的神经痛程度客观评分,经方差分析,治疗期及治疗后的结果显示激光治疗组的疗效明显优于对照组（ｐ＜０．０５～０．０１）;３月后随访,疱疹后神经痛的发生率两组相比亦有显著性差异（ｐ＜０．０１）。并对Ｈｅ－Ｎｅ激光在治疗带状疱疹神经痛的作用机理进行了讨论。     

带状疱疹并发神经痛患者危险因素的相关研究

目的:探讨带状疱疹患者并发神经痛患者的相关危险因素.方法:采用回顾性分析的方法,对我院100例合并带状疱疹后神经痛(PHN)患者年龄、性别、患病后初诊日、急性期发作频度、急性期疼痛程度、疱疹部位、疼痛的性质等进行统计,并进行多因素Logistic相关分析.结果:不同年龄、性别、及疼痛评分间PHN患病率间差异有统计学意义(P＜0.05或P＜0.01).而患病后初诊日及急性期发作频度、不同疱疹部位的PHN患病率、不同疼痛性质的PHN患病率差异无统计学意义(P＞0.05).Logistic相关分析显示,年龄、性别、不同疼痛程度与PHN患病率存在一定的相关性,相关P值分别为0.003、0.002、0.005,均P＜0.01.结论:年龄、性别、不同疼痛程度可影响PHN的发生.针对急性期PHN患者,应早发现,早治疗,提高患者生活质量.     

A型肉毒素治疗带状疱疹后遗神经痛的临床观察

目的:观察A型肉毒素皮内注射治疗带状疱疹后遗神经痛(Postherpetic Neuralgia,PHN)的临床效果。方法:选择76例胸背部带状疱疹后神经痛患者,采用乒乓球抽签法随机分为观察组与对照组,每组38例患者。在口服药物治疗的基础上,观察组与对照组的局部疼痛敏感点分别皮内注射A型肉毒素与生理盐水。比较两组治疗前与治疗后第1、7、30、60天的视觉模拟评分量表(Visual Analogue Scale,VAS)及睡眠质量评分量表(Quality of Sleep,QS)评分的变化。结果:两组患者治疗后第1、7、30、60天的VAS及QS评分均明显低于治疗前(P0.05),观察组患者治疗后第1、7、30、60天的VAS及QS评分结果明显低于对照组(P0.05)。两组均未见明显的治疗相关并发症。结论:A型肉毒素皮内注射疗法可以显著减轻PHN患者的疼痛及改善睡眠质量。     

带状疱疹后遗神经痛患者脑基础活动改变的功能核磁共振研究

带状疱疹后遗神经痛(postherpetic neuralgia,PHN)是临床上一种慢性顽固性神经病理性疼痛,然而,对于其潜在的中枢机制还知之甚少.为了进一步探讨带状疱疹后遗神经痛患者的相关脑区活动,利用功能核磁共振成像低频振幅振荡(ALFF)技术观察带状疱疹后遗神经痛患者的基础脑区活动.8名带状疱疹后遗神经痛患者与8名性别、年龄相匹配的健康者行静息态功能磁共振(f MRI)成像扫描,用SPM8中的多重回归分析,在控制被试年龄、性别、教育年限的影响下,将每个体素的ALFF值同每个被试的病程、视觉模拟评分(visual analog scale,VAS)进行相关分析.与健康志愿者相比,PHN组与VAS评分相关的ALFF值增高的脑区有:右侧小脑后叶、前额叶背外侧区域(BA11/46/47)、右侧顶叶(BA40)、右侧舌回(BA17/18/19);与VAS评分相关的ALFF值降低的脑区有:右侧颞中回(BA21)、左侧舌回(BA17/18)、右侧小脑前叶、左侧后扣带回(BA30/19)和右侧中央前回(BA3/4/6);PHN组与病程相关的ALFF值增高的脑区有:右侧小脑后叶、前额叶背外侧区域(BA9/10/11/47)、左侧颞上回(BA38)、右侧顶叶和右侧舌回(BA17/18/19);与病程相关ALFF值降低的脑区有:左侧海马旁回(BA28)、右侧小脑前叶、左侧扣带回(BA24)、右侧颞上回(BA13)、左侧中央前回和右侧顶下小叶(BA39/40).研究结果提示,涉及疼痛的情绪、警觉行为、注意的脑区在带状疱疹后遗痛慢性疼痛的产生和维持中发挥重要作用.     

带状疱疹疫苗的研究进展及应用

带状疱疹是由潜伏在体内的水痘-带状疱疹病毒再激活引起的一种急性皮肤病,主要发生于老年人和免疫力低下人群。带状疱疹是一种自限性疾病,临床主要表现为带状、成片的皮疹,而其后遗神经痛为该病中最复杂且最常见的一种不良并发症。带状疱疹的发病机制较为复杂,推测与机体的特异性T细胞免疫水平降低有关。本文就带状疱疹与T细胞之间的关系,最新疫苗研究进展进行综述,为疫苗的研发及带状疱疹的预防提供参考。     

脉冲射频术对膝关节骨性关节炎患者膝关节功能及血清IL-7R、TNF-α、IGF水平的影响

摘要 目的：探讨脉冲射频术对膝关节骨性关节炎患者膝关节功能及血清白介素7受体（IL-7R）、肿瘤坏死因子-α（TNF-α）、胰岛素样生长因子（IGF）的影响。方法：选取2018年1月-2020年6月我院接收的90例膝关节骨性关节炎患者,按随机数字表法为观察组和对照组各45例。观察组采用脉冲射频术治疗,对照组采用关节腔内注射玻璃酸钠治疗。观察并比较两组患者的治疗效果、VAS评分、Lysholm膝关节功能评分及血清炎症因子水平。结果：观察组治疗后1个月、3个月的VAS评分低于对照组,Lysholm评分高于对照组（P<0.05）,两组患者治疗后6个月的VAS评分和Lysholm评分比较无统计学差异（P>0.05）。观察组在治疗后6个月的优良率为93.33%,与对照组的88.89%比较差异无统计学意义（P>0.05）。治疗后1个月两组患者IL-7R、TNF-α、IGF水平均低于治疗前,且观察组低于对照组（P<0.05）。结论：脉冲射频术和药物注射治疗膝关节骨性关节炎均有较高的疗效,但脉冲射频术的治疗周期更短,更快的缓解患者的疼痛感,提高膝关节功能,降低炎症因子水平,可在临床上作为首选治疗方法加以推广应用。     

Trigeminal neuralgia: a retrospective study of 188 Thai cases

doi: 10.1111/j.1741‐2358.2011.00530.x Trigeminal neuralgia: a retrospective study of 188 Thai cases Objective: To describe the clinical characteristics and treatment of trigeminal neuralgia (TN) in a group of Thai patients. Materials and methods: Records of 188 patients with TN were reviewed retrospectively for patient demographics, the characteristics of the pain and treatment modalities. Results: Of the 188 patients, 37.2% were men and 62.8% were women. The peak incidence (46.8%) was in the age range of 50–69 years. Pain occurred on the right side of the face more often than on the left (1.8:1). The mandibular division of the trigeminal nerve was the most frequently affected (30.3%), followed by the combined maxillary and mandibular divisions (29.3%) and the maxillary division alone (25%). The majority described their attack as a sharp pain (77.6%), and the most common primary locations were at previous extraction sites (40.5%). The most common triggers were chewing (61.2%) and speaking (47.3%). Carbamazepine was the most common prescribed drug (76.1%) for the initial treatment. Combination drug therapy was introduced when the monotherapy failed to control the pain. Surgical intervention was the alternative choice of treatment in refractory cases. Conclusion: TN affected women more than men, and this disorder occurred most frequently in patients aged 50 years and older. The mandibular division of the trigeminal nerve was most commonly involved.     

脉冲电场对液体中细菌作用的实验

本文对脉冲电场杀灭液体中的细菌进行了研究。实验结果表明,电场可全部杀死液体中的细菌,不破坏营养成份。电场灭菌的原因是电场破坏了细胞膜作为半透膜的物质交换机能。     

Effects of the suppression of acute herpetic pain by gabapentin and amitriptyline on the incidence of delayed postherpetic pain in mice

The inoculation of mice with herpes simplex virus type-1 (HSV-1) causes herpes zoster-like skin lesions and pain-related responses (tactile allodynia and mechanical hyperalgesia) from day 5 after inoculation. Skin lesions completely heal by day 15 after inoculation, but about half of mice with acute herpetic pain show pain-related responses long after the lesions heal. Using this mouse model, we examined the effects of repeated administration of gabapentin and amitriptyline on the acute herpetic pain and the incidence of postherpetic pain. Gabapentin and amitriptyline were administered three times daily from day 5 to 11 after inoculation. Postherpetic pain-related responses were assessed on day 30 after inoculation. Gabapentin (10-100 mg/kg) produced the dose-dependent inhibition of acute herpetic pain-related responses. This medication produced marked reduction in the incidence of delayed postherpetic pain and the dose of 100 mg/kg produced the complete inhibition. Amitriptyline (10 mg/kg) did not affect the acute pain-related responses in the initial 3- and 2-day periods and then gradually inhibited them. This dosage produced a substantial but non-significant decrease in the incidence of postherpetic pain-related responses. Amitriptyline (1 and 3 mg/kg) was without effects on acute herpetic and postherpetic pain-related responses. The results strongly support the idea that the severity of the acute herpetic pain is a risk factor of postherpetic neuralgia. It may be worth testing the effects of gabapentin on acute herpetic pain and the incidence of postherpetic neuralgia in human subjects.     

A circular waveguide irradiation system for nonhuman primates: design and dosimetry

A 275-MHz exposure system, consisting of a circular waveguide irradiator and a transparent plastic animal cage, has been developed to accommodate rhesus monkeys weighing up to 15 kg. The vertically oriented waveguide is composed primarily of stainless steel and is fitted with an inner cage fabricated from a tubular section of acrylic plastic. Circularly polarized electromagnetic energy at 275 MHz, either pulsed or continuous wave (CW), can be propagated from the removable top section of the waveguide. The cage is designed to function as the monkey's permanent home. It is fitted with a lever-actuated behavioral performance device on which the monkey responds according to a predetermined schedule to obtain a daily food ration. The system can be adapted to provide for the collection of metabolic and physiologic data as well. Dosimetric measurements were conducted with six rhesus monkeys weighing 3.0-7.2 kg and with a 4-kg model. The dosimetric results show that about one-third of the net incident energy is absorbed by a subject in this system at a normalized specific absorption rate (SAR) of 0.33 (W/kg)/(mW/cm2).