带状疱疹及后遗神经痛.ppt

Treating herpes zoster and postherpetic neuralgia: An evidence-based approachUniversity of Rochester School of Medicine and Dentistry, Rochester, NY Annie.Philip,MBBS ? 以证据为基础的方法治疗带状疱疹和带状疱疹后遗神经痛 罗切斯特大学医学院和牙科，罗切斯特，纽约 安妮·菲利普，医学学士 Postherpetic neuralgia (PHN) is a management challenge—because 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。 And, as the most common complication of an acute episode of herpes zoster (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。 Herpes 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 number 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。 Major risk?factors for development of PHN after an episode of herpes zoster include:? older age? greater acute pain during herpes zoster? greater 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 PHN 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 episodic 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） In addition, some 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。 More than 90% of patients who have PHN have allodynia,7