Winnie A P, Hartwell P W
Department of Anesthesiology & Critical Care, Cook County Hospital, Chicago, IL 60612.
Reg Anesth. 1993 Sep-Oct;18(5):277-82.
Since Rosenak's original report more than 50 years ago as to the efficacy of sympathetic blocks in terminating acute herpes zoster, many investigators have reported that a more important benefit of this form of therapy is the prevention of post-herpetic neuralgia. However, most of these reports have indicated that sympathetic blocks are effective in preventing post-herpetic neuralgia only if applied soon after the onset of the acute phase of the disease; in fact, if applied too late, this form of therapy failed to prevent the development of post-herpetic neuralgia. The present study was carried out to determine more precisely the relationship between the time of treatment of acute herpes zoster and the prevention of post-herpetic neuralgia and to attempt to correlate this time with the authors' previously published theory on the mechanism by which sympathetic blocks provide the therapeutic benefit.
The present study was a retrospective review of 122 patients treated at variable intervals after the onset of acute herpes zoster. Data tabulated included the duration of symptoms at the time of treatment, the number of sympathetic blocks required to provide relief, and the efficacy of the sympathetic blockade in terminating the acute phase of herpes zoster and then preventing the development of post-herpetic neuralgia.
According to the data obtained in this retrospective study, sympathetic blocks terminated the pain of acute herpes zoster and prevented or relieved post-herpetic neuralgia in more than 80% of patients treated within 2 months of the onset of the acute phase of the disease, after which time the success rate decreased drastically.
Sympathetic blockade applied within the first 2 months after the onset of acute herpes zoster terminated the acute phase of the disease, probably by restoring intraneural blood flow, thus preventing the death of the large fibers and avoiding the development of post-herpetic neuralgia. If sympathetic blocks were to be carried out after 2 months, the damage to the large fibers would be irreversible, and this therapeutic modality would not be able to prevent the development of post-herpetic neuralgia.
自50多年前罗塞纳克首次报告交感神经阻滞对终止急性带状疱疹的疗效以来，许多研究者报告称，这种治疗方式更重要的益处是预防带状疱疹后神经痛。然而，这些报告大多表明，交感神经阻滞仅在疾病急性期发作后不久应用时，才对预防带状疱疹后神经痛有效；事实上，如果应用过晚，这种治疗方式无法预防带状疱疹后神经痛的发生。本研究旨在更精确地确定急性带状疱疹的治疗时间与预防带状疱疹后神经痛之间的关系，并尝试将这一时间与作者此前发表的关于交感神经阻滞提供治疗益处的机制理论联系起来。
本研究是对122例急性带状疱疹发作后在不同时间间隔接受治疗的患者进行的回顾性分析。汇总的数据包括治疗时的症状持续时间、缓解疼痛所需的交感神经阻滞次数，以及交感神经阻滞在终止带状疱疹急性期及预防带状疱疹后神经痛发生方面的疗效。
根据这项回顾性研究获得的数据，对于在疾病急性期发作后2个月内接受治疗的患者，超过80%的患者交感神经阻滞终止了急性带状疱疹的疼痛，并预防或缓解了带状疱疹后神经痛，此后成功率急剧下降。
急性带状疱疹发作后的前2个月内进行交感神经阻滞可终止疾病的急性期，可能是通过恢复神经内血流，从而防止大纤维死亡并避免带状疱疹后神经痛的发生。如果在2个月后进行交感神经阻滞，大纤维的损伤将不可逆转，这种治疗方式将无法预防带状疱疹后神经痛的发生。
