带状疱疹及后遗神经痛--课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,ppt课件,*,Treating herpes zoster and postherpetic neuralgia:An evidence-based approach,University 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,1,ppt课件,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。,2,ppt课件,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。,3,ppt课件,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。,4,ppt课件,Major riskfactors 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,5,ppt课件,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 sensation,6,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）,6,ppt课件,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。,7,ppt课件,More 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 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。,8,ppt课件,In 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，也提供预防带状疱疹的策略。,9,ppt课件,ACUTE HERPES ZOSTER:START ANTIVIRALS EARLY,Evidence-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。,10,ppt课件,Antiviral agents,suppress viral replication and have a beneficial effect on acute and chronic pain.Acyclovir(800 mg,5 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和安全性。,11,ppt课件,In 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。,12,ppt课件,In terms of duration,a study comparing famciclovir treatment with placebo showed that subjects in the placebo group had persistent pain for 163 days,whereas famciclovir-treated patients had pain for 63 days.,9,在持续性方面：一个关于伐昔洛韦治疗组和安慰组的研究表明：安慰剂组患者疼痛持续,163,天，而伐昔洛韦治疗组患者疼痛持续,63,天。,13,ppt课件,Based on this evidence,antiviral medications are strongly recommended for treating herpes zoster,especially for patients at increased risk of developing PHN.Antiviral treatment should be started within 72 hours of the onset of the rash.,基于这些证据，强烈推荐使用抗病毒药物治疗带状疱疹的患者，尤其是可能发展为带状疱疹后遗神经痛的患者。抗病毒治疗应该在皮疹出现,72,小时内使用。,14,ppt课件,No good evidence supports the efficacy of antiviral treatment administered 72 hours after the onset of rash.One uncontrolled trial,however,examined the effectiveness of acyclovir started before vs after 72 hours;the difference in pain persistence was not significant between the groups,suggesting acyclovir has benefit even when given after 72 hours.,10,没有有力的证据表明皮疹出现,72,小时以后阿昔洛韦的疗效。一个不受控制的实验，用来调查阿昔洛韦分别在（皮疹出现）,72,小时之前和之后使用（的疗效）。在这两组中，疼痛的持续性没明显区别，这表明即使在（皮疹出现）,72,小时之后使用阿昔洛韦仍有疗效。,15,ppt课件,In clinical practice,the diagnosis of herpes zoster is often not made within 72 hours of symptom onset;nevertheless,it is important to identify patients who could still benefit from antiviral medication even when treatment is started relatively late in the disease course.This is especially true in ocular zoster,because viral shedding may continue beyond 72 hours.,11,在临床实践中，带状疱疹往往未在发病的,72,小时内明确诊断。而然，明确（带状疱疹）患者是非常重要的，在较晚的病情开始使用抗病毒治疗仍有益处，尤其是在眼部的带状疱疹，因为病毒脱落可能持续超过,72,小时。,16,ppt课件,Analgesics,are part of a practical approach