解放军医学杂志2025，Vol.50Issue(12)：1517-1523,7.DOI:10.11855/j.issn.0577-7402.0588.2025.0922
基于倾向性评分匹配观察胸椎旁神经阻滞治疗不同亚型带状疱疹相关性疼痛的中长期疗效
Medium-and long-term efficacy of thoracic paravertebral nerve block for different subtypes of zoster-associated pain:a propensity score-matched study
摘要
Abstract
Objective To observe the medium-and long-term efficacy of thoracic paravertebral nerve block(TPVB)in treating different subtypes of zoster-associated pain(ZAP).Methods A retrospective analysis was conducted on the clinical data of 124 ZAP patients who received ultrasound-guided TPVB treatment at the Department of Pain Treatment,Hainan Hospital of Chinese PLA General Hospital from January 2022 to December 2023.Before treatment,patients were divided into 4 subtypes according to their pain types:irritable nociceptor type,deafferentation type,mixed type,and non-irritable nociceptor type.Propensity score matching(PSM)was used to match patients'gender,age,disease duration,involved nerve segments,and status of comorbid hypertension,diabetes,and malignant tumors,as well as pre-treatment visual analog scale(VAS)for pain,self-rating anxiety scale(SAS),and Pittsburgh sleep quality index(PSQI)scores at a 1:1 ratio.After excluding confounding factors,36 patients were included in each of irritable and mixed subtype groups for final analysis.All patients received oral medication combined with ultrasound-guided TPVB treatment.The VAS,SAS,and PSQI scores of patients in both groups were evaluated before treatment and at 3,6,and 12 months after treatment.Additionally,the nerve injury repair status of ZAP patients was observed,the overall efficacy was evaluated at 12 months after treatment,and the follow-up treatment information of patients in both groups was collected.Results Before treatment,there were no significant differences in VAS,SAS,and PSQI scores between the two groups(P>0.05).At 3,6,and 12 months after treatment,the VAS,SAS,and PSQI scores of both groups were significantly lower than those before treatment(P<0.05).Among these time points,the VAS,SAS,and PSQI scores of irritable nociceptor group at each time point were significantly lower than those of mixed-type group(P<0.05).At 12 months after treatment,the overall treatment effective rate of irritable nociceptor group was significantly higher than that of mixed-type group(P<0.05).At 12 months after treatment,the residual symptoms after nerve injury in both groups were significantly improved compared with those before treatment,and the improvement rate of skin tenderness was significantly better than that of other symptoms(P<0.05).Within 12 months after one course of treatment,the duration of continuous analgesic use in irritable nociceptor group was shorter than that in mixed-type group.The number of patients who required subsequent remedial TPVB treatment for analgesia and the number of such treatments were significantly fewer in irritable nociceptor group than those in mixed-type group(P<0.05).Conclusions Ultrasound-guided TPVB therapy provides sustained,effective relief of pain,alleviates anxiety and sleep disturbances,promotes nerve injury repair,and is particularly effective in improving skin tenderness in patients with different ZAP subtypes.It demonstrates superior efficacy for irritable nociceptor type,additionally reducing the required duration of analgesic use and the need for remedial analgesia in these patients.关键词
带状疱疹相关性疼痛/胸椎旁神经阻滞/亚型/中长期疗效Key words
zoster-associated pain/thoracic paravertebral nerve block/subtype/medium-and long-term efficacy分类
医药卫生引用本文复制引用
Mao Xiao-Qing,Liu Lin,Ni Juan-Juan,Zhao Dan,Jia Xu,Sun Li,Gao Ming-Long..基于倾向性评分匹配观察胸椎旁神经阻滞治疗不同亚型带状疱疹相关性疼痛的中长期疗效[J].解放军医学杂志,2025,50(12):1517-1523,7.基金项目
This work was supported by the Incubation Project of Military Medical Science and Technology Youth Cultivation Program(19QNP059) 军队医学科技青年培育计划孵化项目(19QNP059) （19QNP059）
