中国麻风皮肤病杂志 ›› 2025, Vol. 41 ›› Issue (3): 166-171.doi: 10.12144/zgmfskin202503166

• 论著 • 上一篇    下一篇

皮下注射肿胀麻醉液治疗带状疱疹后遗神经痛疗效评价及影响因素分析

刘云1,2,3,谢卫星1,2,吴晓晓1,2,李文超1,2,王红蕾1,2,谢凯1,2,曹楠1,2,王学庆1,2,李珍1,2,刘国艳1,2,刘红1,2,3,张福仁1,2   

  1. 1山东第一医科大学附属皮肤病医院，山东济南，250022；2山东省皮肤病性病防治研究所，山东济南，250022；3山东第一医科大学（山东省医学科学院）公共卫生与健康管理学院，山东济南，250117
  • 出版日期:2025-03-15 发布日期:2025-03-03

Analysis of efficacy of subcutaneous injection of swelling anesthetic solution in treating postherpetic neuralgia and influencing factors

LIU Yun1,2,3, XIE Weixing1,2, WU Xiaoxiao1,2, LI Wenchao1,2, WANG Honglei1,2, XIE Kai1,2, CAO Nan1,2, WANG Xueqing1,2, LI Zhen1,2, LIU Guoyan1,2, LIU Hong1,2,3, ZHANG Furen1,2   

  1. 1 Hospital for Skin Diseases, Shandong First Medical University, Jinan 250022, China; 2 Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan 250022, China; 3 School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
  • Online:2025-03-15 Published:2025-03-03

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摘要： 目的：评估皮下注射治疗带状疱疹后神经痛（postherpetic neuralgia,PHN）患者的疗效，并分析影响疗效的因素。方法：回顾性分析2020年1月1日至2023年6月1日我院诊断为PHN且重度疼痛（NRS≥7）的患者资料。将患者按照治疗方式分为三组,单独皮下注射组（肿胀麻醉液为生理盐水500 mL, 2%利多卡因15 mL, 10%碳酸氢钠10 mL，1∶1000的肾上腺素0.5 mL,曲安奈德注射液50 mg)、单独普瑞巴林组、皮下注射联合普瑞巴林组。采用配对t检验比较治疗前后疼痛评分的变化，多因素logistic回归分析影响疗效的因素，卡方检验比较组间疗效。结果：研究对象共333例，其中单独皮下注射组31例，单独普瑞巴林组158例，皮下注射联合普瑞巴林组144例。接受皮下注射1个月后，患者的疼痛评分显著降低（8.42±1.02 vs. 5.19±2.50，P<0.05）。皮下注射一次有效率为42.31%，两次有效率为88.89%。疼痛面积越大、PHN病程大于1个月、带状疱疹急性期剧烈疼痛可降低皮下注射肿胀麻醉液的有效率，注射2次及以上、联合普瑞巴林可增加皮下注射肿胀麻醉液的有效率（P<0.05）。皮下注射联合普瑞巴林在缓解患者疼痛方面优于仅皮下注射和仅口服普瑞巴林 （P＜0.05）。结论：皮损面积、PHN病程、注射次数、带状疱疹急性期是否疼痛以及是否联合普瑞巴林是影响皮下注射疗效的因素。皮下注射联合普瑞巴林能明显缓解重度PHN患者的疼痛。

关键词: 皮下注射, 带状疱疹后遗神经痛, 普瑞巴林

Abstract: Objective: To evaluate the efficacy of subcutaneous injection in the treatment of postherpetic neuralgia (PHN), and to analyze the factors influencing treatment outcomes. Methods: Data of patients diagnosed with PHN and severe pain (NRS≥7) in our hospital from January 1, 2020 to June 1, 2023 were retrospectively analyzed. The patients were divided into three groups according to the treatment methods, including subcutaneous injection alone group (swelling anesthesia solution was normal saline 500 mL, 2% lidocaine 15 mL, 10% sodium bicarbonate 10 mL, 1∶1000 epinephrine 0.5 mL, triamcinolone acetonide injection 50 mg), pregabalin alone group, subcutaneous injection combined with pregabalin group. Paired t test was used to compare the changes of pain score before and after treatment. Multivariate logistic regression analysis was performed to analyze the factors affecting the efficacy, and chi-square test was used to compare the efficacy between the two groups. Results: A total of 333 patients were enrolled, including 31 patients in the subcutaneous injection group, 158 patients in the pregabalin group, and 144 patients in the subcutaneous injection combined with pregabalin group. One month after injections, patients experienced significantly lower pain score （8.42 ± 1.02 vs. 5.19 ± 2.50, P<0.05）. Subcutaneous injections were effective in 42.31% after one application and 88.89% after two. Factors affecting efficacy included pain area, more than one duration of PHN and severe pain in the acute phase of herpes zoster were risk factors for inefficiency, while two or more injections and combination with pregabalin were protective factors （P<0.05）. Subcutaneous injection combined with pregabalin was superior to subcutaneous injection only and oral pregabalin only in relieving patients' pain （P<0.05）. Discussion: The area of lesions, the course of PHN, the number of injections, whether there is pain during the acute phase of herpes zoster and whether pregabalin is combined are factors affecting the efficacy of subcutaneous injection. Subcutaneous injection combined with pregabalin can significantly relieve the pain of patients with severe PHN.

Key words: subcutaneous injection, postherpetic neuralgia, pregabalin