带状疱疹及后遗神经痛课件.ppt
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- 带状疱疹 神经痛 课件
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1、Postherpetic neuralgia(PHN)is a management challengebecause of its severity,long duration,and potential for debilitation,often in the highly vulnerable elderly population.带状疱疹后遗神经痛(PHN)是一个治疗的挑战,因为其严重程度、持续时间长、和常常潜伏在免疫力低下的老年人口中。2And,as the most common complication of an acute episode of herpes zoster(
2、shingles)in an immunocompetent person,PHN is likely no stranger to your practice.而且,在具有免疫力的人中,作为急性带状疱疹(带状疱疹)最常见的并发症,在你的临床实践中疱疹后神经痛并不少见。3Herpes zoster is one of the most common neurological problems,with an incidence of up to 1 million new cases per year in the United States.Although the precise numb
3、er for the prevalence of PHN in the United States is unknown,investigators estimate it at 500,000 to 1 million 带状疱疹是一种最常见的神经系统的疾病,在美国,其发病率高达每年100万新增病例。虽然疱疹后神经痛患病率的确切数目在美国是未知的,但调查人员估计在50万-100万。4Major risk factors for development of PHN after an episode of herpes zoster include:older agegreater acute
4、pain during herpes zostergreater severity of rash 带状疱疹发生后,发展为带状疱疹后遗神经痛的主要危险因素包括:年龄 带状疱疹期更严重的疼痛 更严重的皮疹5PHN is commonly defined as“dermatomal pain that persists 120 days or more after the onset of rash.”5 The pain of PHN has been characterized as a stimulus-dependent continuous burning,throbbing,or ep
5、isodic sharp electric shock-like sensation6 and as a stimulus-dependent tactile allodynia(ie,pain after normally nonpainful stimulus)and hyperalgesia(exaggerated response to a painful stimulus).带状疱疹后遗神经痛通常定义为:“皮区出现皮疹后疼痛持续120天或更久。带状疱疹后遗神经痛的特点是:连续的烧灼感、闪电痛、触摸痛(即是无痛刺激后的疼痛)和痛觉超敏(疼痛刺激的放大反应)6In addition,so
6、me patients experience myofascial pain secondary to excessive muscle guarding.Chronic pruritus can be present.此外,有些病人的经验肌筋膜疼痛继发过度肌肉防御,可以产生慢性瘙痒。7More than 90%of patients who have PHN have allodynia,7 which tends to occur in areas where sensation is relatively preserved.Patients also feel spontaneous
7、pain in areas where sensation is lost or impaired.带状疱疹后遗神经痛患者超过90%有触摸痛,这往往发生在感觉相对保存的地方。在感觉丧失或受损的地方,患者也有自发性疼痛。8In this article,we review the evidence for the range of treatments for acute herpes zoster and PHN,as well offer preventive strategies for herpes zoster.在本文中,我们回顾急性带状疱疹和疱疹后神经痛范围内的治疗证据,也提供预防带
8、状疱疹的策略。9ACUTE HERPES ZOSTER:START ANTIVIRALS EARLYEvidence-based treatment of acute herpes zoster includes antiviral drugs and analgesics.急性带状疱疹:早期使用抗病毒药物以证据为基础的治疗急性带状疱疹包括抗病毒药物和止痛药。10Antiviral agents suppress viral replication and have a beneficial effect on acute and chronic pain.Acyclovir(800 mg,5
9、 times a day),valacyclovir(1000 mg,every 8 hours),and famciclovir(500 mg,every 8 hours)are antivirals commonly used to treat herpes zoster.All 3 drugs have comparable efficacy and safety profiles.抗病毒药物抑制病毒复制,有利于治疗急性和慢性疼痛。阿昔洛韦(800毫克,每日5次),伐昔洛韦(1000毫克,每8小时),和泛昔洛韦(500毫克,每8小时)是常用的治疗带状疱疹的抗病毒药物,3种药物有类似的疗效
10、和安全性。11In a meta-analysis of patients older than 50 years who were treated with acyclovir or placebo,pain persisted in 15%of the acyclovir-treated group,compared with 35%of the placebo group.8 meta分析中,使用阿昔洛韦治疗或安慰剂的年龄超过50岁的患者,阿昔洛韦治疗组中15%的患者有后遗痛,相比下,安慰剂组中35%的患者有后遗痛。12In terms of duration,a study compa
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