张晓荣++陈文琦

[摘要] 目的 探讨早期应用加巴喷丁治疗老年带状疱疹神经痛的效果和安全性。 方法 选取南京医科大学附属南京医院皮肤科门诊2014年1月～2015年3月就诊的年龄≥60岁、视觉模拟（VAS）评分>4分的急性期带状疱疹患者80例，根据随机数字表法分为治疗组和对照组，每组各40例。对照组常规予更昔洛韦抗病毒和甲钴胺营养神经治疗，治疗组在此基础上给予加巴喷丁，评价连续用药1、2、4周后疼痛的缓解情况及不良反应。 结果 治疗1周后，治疗组VAS评分[（5.53±0.21）分]较对照组[（6.92±0.23）分]明显下降，差异有统计学意义（P < 0.05）；治疗神经痛有效率（90.0%）高于对照组（70.0%），差异有统计学意义（P < 0.05）。治疗4周后，治疗组VAS评分[（2.20±0.11）分]明显低于对照组[（3.41±0.26）分]，差异有统计学意义（P < 0.05）；治疗神经痛有效率（100.0%）高于对照组（90.0%），差异有统计学意义（P < 0.05）。治疗组治疗带状疱疹的疼痛缓解时间、疼痛缓解程度明显优于对照组，差异有统计学意义（P < 0.05）；头晕、嗜睡等不良反应发生率高于对照组，差异有统计学意义（P < 0.05），但无其他严重不良反应。 结论 早期应用加巴喷丁对老年带状疱疹的神经痛有显著缓解作用，可能会降低后遗神经痛的发生率，且无严重不良反应，具有临床使用价值。

[关键词] 加巴喷丁；带状疱疹；神经痛

[中图分类号] R752.12 [文献标识码] A [文章编号] 1673-7210（2015）09（b）-0004-05

Effect of early application of Gabapentin in the treatment of senile herpes zoster neuralgia

ZHANG Xiaorong CHEN Wenqi

Department of Dermatology， Nanjing Hospital Affiliated to Nanjing Medical University Nanjing First Hospital， Jiangsu Province， Nanjing 210006， China

[Abstract] Objective To observe the effect and safety of early application of Gabapentin in the treatment of senile herpes zoster neuralgia. Methods From January 2014 to March 2015， in Department of Dermatology， Nanjing Hospital Affiliated to Nanjing Medical University， 80 acute herpes zoster outpatients with ≥ 60 years old and visual analogue scales （VAS） >4 scores were selected. They were divided into two groups according to random number table， with 40 cases in each group. The control group was treated with conventional Ganciclovir and Mecobalamine， the treatment group was treated with Gabapentin based on conventional therapy. After continuous treatmnet 1， 2， 4 weeks， pain relief and adverse reaction of two groups were evaluated. Results After treatment 1 week， VAS of the treatment group [（5.53±0.21） scores] was significantly lower than that of the control group [（6.92±0.23） scores]， the difference was statistically significant （P < 0.05）； and the effect rate of neuralgia treatment of the treatment group （90.0%） was higher than that of the control group （70.0%）， the difference was statistically significant （P < 0.05）. After treatment 4 weeks， VAS of the treatment group [（2.20±0.11） scores] was significantly lower than that of the control group [（3.41±0.26） scores]， the difference was statistically significant （P < 0.05）； and the effect rate of neuralgia treatment of the treatment group （100.0%） was higher than that of the control group （90.0%）， the difference was statistically significant （P < 0.05）. The time and degree of pain relief of the treatment group were significantly better than those of the control group， the differences were statistically significant （P < 0.05）. The incidence of adverse reactions such as dizziness and sleepiness in the treatment group was significantly higher than that in the control group， the difference was statistically significant （P < 0.05）， and no other significant adverse reactions occurred. Conclusion Early application of Gabapentin is significantly effective in the treatment of herpes zoster neuralgia， which probably reduces the occurrence rate of PHN， and no severe adverse reactions occur， it has clinical use value.

[Key words] Gabapentin； Herpes zoster； Neuralgia

带状疱疹作为皮肤科常见的疾病之一，是由水痘-带状疱疹病毒（VZV）引起的急性炎症性皮肤病。对老年患者而言，该病导致的神经痛较重，时间较长，且后遗神经痛（postherpetic neuralgia，PHN）的发生率较高，严重影响生活质量。有研究认为，PHN的发生与年龄和急性期的疼痛程度相关，此外还与患者的机体以及社会因素相关[1]。因此，治疗老年性带状疱疹的重要环节就是减轻急性期神经痛和预防后遗神经痛的发生，这也是临床关注的重点。近年来，新型抗癫痫药物加巴喷丁被认为是治疗PHN的一种有效的药物，多用于带状疱疹后遗神经痛的治疗。早期应用加巴喷丁治疗老年带状疱疹是否可以有效缓解急性期神经痛，是否可以有效降低PHN的发生，国内文献报道较少。笔者选取南京医科大学附属南京医院（以下简称“我院”……