加巴喷丁联合星状神经节阻滞治疗慢性紧张性头痛的临床研究

加巴喷丁联合星状神经节阻滞治疗慢性紧张性头痛的临床研究

王扬

哈尔滨市第五医院 黑龙江 哈尔滨 150040

摘要：目的：探讨加巴喷丁联合星状神经节阻滞对慢性紧张性头痛患者的临床疗效和安全性。方法：选取我院于2017年1月-2018年1月期间收治的慢性紧张性头痛患者88例，随机分为试验组44例和对照组44例，所有研究对象均口服加巴喷丁治疗，起始剂量100～200mg·d－1，根据疗效逐渐调整。试验组患者联合星状神经节阻滞，每周二、五各1次；对照组患者加服乙哌立松50mg，每天3次。治疗前及每周五用视觉模糊评分评价疼痛强度，治疗前及治疗第2，4周的周五评价抑郁焦虑情况，治疗前及治疗4周后进行生活质量评定。结果：治疗后，2组患者疼痛评分较治疗前显著降低；试验组患者加巴喷丁药量明显少于对照组；治疗后，2组患者抑郁和焦虑均有明显减轻；治疗14d，试验组和对照组比较；治疗28d，试验组患者抑郁均明显低于对照组。结论：加巴喷丁联合星状神经节阻滞对慢性紧张性头痛患者疗效较好，患者依从性好，不良反应发生率低。

关键词：加巴喷丁；星状神经节阻滞；慢性紧张性头痛

Clinical study of gabapentin combined with stellate ganglion block in the treatment of chronic tension headache

Abstract: Objective: To investigate the clinical efficacy and safety of gabapentin combined with stellate ganglion block in patients with chronic tension headache. METHODS: Eighty-eight patients with chronic tension headache admitted to our hospital from January 2017 to January 1818 were randomly pided into the experimental group (44 cases) and the control group (44 cases). All subjects were treated with gabapentin orally. 100 ~ 200mg · d-1, gradually adjusted according to the efficacy. Patients in the experimental group were treated with stellate ganglion block, once every two or five times a week; patients in the control group were given eperisone 50 mg three times a day. Pain intensity was assessed by visual blur scale before treatment and every Friday, and depression and anxiety were evaluated before treatment and on the 2nd and 4th week of treatment, and quality of life was assessed before treatment and after 4 weeks of treatment. RESULTS: After treatment, the pain scores of the two groups were significantly lower than those before treatment; the dose of gabapentin in the test group was significantly less than that of the control group; after treatment, the depression and anxiety were significantly reduced in the two groups; the treatment group and the control group were treated for 14 days. Compared with the control group, the depression in the experimental group was significantly lower than that in the control group. Conclusion: Gabapentin combined with stellate ganglion block is effective in patients with chronic tension headache, with good patient compliance and low incidence of adverse reactions.

Key words: gabapentin; stellate ganglion block; chronic tension headache

慢性紧张性头痛是临床上常见的顽固性难治性头痛^[1]。目前的治疗药物有非甾体抗炎药、镇静、肌松药和抗抑郁等对症治疗，但部分患者疗效不佳，症状易复发，严重影响工作和生活质量。加巴喷丁为γ－氨基丁酸(GABA)的衍生物，广泛应用于临床镇痛。本研究旨在观察加巴喷丁联合星状神经节阻滞对慢性紧张性头痛患者的临床疗效及安全性。

资料与方法

1.1一般资料

选取我院于2017年1月-2018年1月期间收治的慢性紧张性头痛患者88例，随机分为对照组和试验组，各44例。对照组男15例，女29例，年龄15~57岁，平均年龄(36.1±7.6)岁。试验组男16例，女28例，年龄16~58岁，平均年龄(36.9±7.1)岁。两组患者一般资料比较，差异无统计学意义(P>0.05)，具有可比性。

1.2方法

88例慢性紧张性头痛患者随机分为试验组和对照组，各44例。所有研究对象均口服加巴喷丁治疗，起始剂量为100～200mg·d－1，然后根据患者治疗情况调整用药剂量，一般2周逐渐升至500mg·d－1，每天2次。试验组患者每周二、五分别行星状神经节阻滞，每次单侧阻滞，左右侧依次轮换。对照组患者口服盐酸乙哌立松片50mg，每天3次。2组疗程均为4周。

星状神经节阻滞方法按照文献^[2]，确认针尖已达星状神经节附近，即可注入1%利多卡因8～10mL。阻滞成功后患者出现Horner综合征、面颈及手掌皮肤温度升高等体征。

结果

治疗后，2组患者疼痛评分较治疗前显著降低；试验组患者加巴喷丁药量明显少于对照组；治疗后，2组患者抑郁和焦虑均有明显减轻；治疗14d，试验组和对照组比较；治疗28d，试验组患者抑郁均明显低于对照组。

两组治疗前后心理状态比较

讨论

紧张性头痛在慢性头痛中最常见，女性多见，病程迁延，表现为双侧枕颞部或头部的紧缩性或压迫性疼痛，常间断伴有头昏、焦虑、抑郁、失眠或胃肠不适等躯体症状^[3]。加巴喷丁可通过增强γ－氨基丁酸(GABA)的作用而抑制头痛的发作，减少头痛发作频率，长期口服会造成较严重的不良反应，患者依从性差，治疗效果不佳。加巴喷丁能明显消除紧张性头痛患者不良情绪，提高生活质量。本研究发现，加巴喷丁联合星状神经节阻滞治疗对慢性紧张性头痛产生协同效应，患者依从性好，治疗效果明显。

加巴喷丁联合星状神经节阻滞可明显减轻患者的抑郁症状，改善患者的生活质量。此外，星状神经节阻滞可明显减少患者加巴喷丁的用量，降低治疗期间的不良反应发生率,值得推广。

参考文献：

[1]贾建平.神经病学[M].6版.北京:人民卫生出版社，2011，167.

[2]赵东，刘兆华，尚红，等.星状神经节阻滞治疗紧张性头痛16例分析[J].河南大学学报(医学版)，2005(24):48-49.

[3]李艺，唐亚梅，李毕琴，等.普瑞巴林与氟哌噻吨美利曲辛治疗紧张性头痛的疗效比较[J].广东医学，2014(35):596－598.