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摘要：
目的 观察对比超声引导竖脊肌平面阻滞（erector spinae plane block, ESPB）与超声引导椎旁神经阻滞（paravertebral nerve block, PVB）治疗老年带状疱疹性神经痛的疗效。 方法 90例老年带状疱疹患者，按随机数字表法分为竖脊肌平面阻滞组（E组）和椎旁神经阻滞组（P组），每组45例。两组均行抗病毒、营养神经和口服镇痛药物治疗，在此基础上E组行ESPB治疗，P组行PVB治疗，所有患者住院期间均接受两次治疗。记录两组患者治疗前及治疗后1周、1个月、2个月、3个月的疼痛数字评分（Numerical Rating Scale, NRS），治疗前及治疗后1个月、2个月、3个月的睡眠状况自评量表（Self‑Rating Scale of Sleep, SRSS）评分；记录两组患者疱疹皮损愈合时间，治疗操作时长，患者满意度，治疗期间镇痛药物使用量和补救用药情况，治疗后1周、1个月、2个月、3个月镇痛药物使用率及不良反应发生情况；随访疱疹皮损完全愈合后1个月疱疹后神经痛（postherpetic neuralgia, PHN）的发生情况。 结果 与治疗前比较，两组患者治疗后各时点NRS和SRSS评分降低（P<0.05）；两组治疗前及治疗后各时点NRS和SRSS评分组间比较，差异无统计学意义（P>0.05）。E组治疗操作时长短于P组（P<0.05），两组皮损愈合时间、治疗期间镇痛药物使用量和补救用药情况、住院时间、患者满意度、PHN发生情况、治疗后各时点镇痛药物使用率、不良反应发生情况比较，差异均无统计学意义（P>0.05）。 结论 ESPB治疗老年带状疱疹性神经痛的疗效不劣于PVB，且其操作更为简单、安全。
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Abstract: Objective This study aims to compare the effect of ultrasound‑guided erector spinae plane block (ESPB) with the effect of ultrasound‑guided paravertebral nerve block (PVB) in treating acute thoracic herpes zoster pain. Methods Ninety patients who are over 60 years of age with acute thoracic herpetic eruption were assigned to the erector spinae plane block group (group E, n=45) and the paravertebral nerve block group (group P, n=45) according to the random number table method, which received ESPB and PVB, respectively. Both groups were also treated with conventional drug treatment including antiviral agents and analgesics. The curative effect was evaluated by Numerical Rating Scale (NRS) at the time of pre‑treatment, 1 week, and 1, 2 and 3 months after the treatment and Self⁃Rating Scale of Sleep (SRSS) at the time of pre‑treatment and 1, 2 and 3 months after the treatment. Time used for injection, time to healing of the skin eruption, hospitalization time, patient's satisfaction with recovery, the use of analgesics and rescue analgesia during the treatments, and adverse reactions were recorded. The proportion of patients consuming analgesics at the time of 1, 2 and 3 months after the treatment and the incidence of postherpetic neuralgia (PHN) were also recorded. Results NRS and SRSS in both groups significantly decreased at different time points after treatments compared with the basal level (P<0.05); however, there was no significant difference in NRS and SRSS between the two groups. The time used for injection was shorter in group E than that in group P (P<0.05). There were no statistical differences in time to healing of the skin eruption, hospitalization time, patient's satisfaction with recovery, the use of analgesics and rescue analgesia during the treatments, adverse reactions, the proportion of patients consuming analgesics after the treatments, and the incidence of PHN between two groups (P>0.05). Conclusions The analgesic effect of ESPB is as potent as that of PVB in the treatment of herpetic neuralgia. But ESPB seems a simpler and safer operation.
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