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目的评估利多卡因浸润鼻腔黏膜治疗急性上呼吸道感染相关性鼻内神经痛的临床疗效及安全性。方法 2014年10月—2015年12月,选取首都医科大学宣武医院符合纳入与排除标准的急性上呼吸道感染相关性鼻内神经痛患者40例为研究对象。采用随机数字表法将其分为利多卡因组(A组)和0.9%氯化钠溶液组(B组),各20例。分别用蘸有1%利多卡因药液和0.9%氯化钠溶液的棉签浸润A组和B组患者鼻腔黏膜,3~5 min/次,时间间隔1~3 min,共浸润5~10次。记录患者治疗前和首次治疗后即刻、1、4、7 d总体疼痛、鼻部疼痛、眼部疼痛的疼痛视觉模拟评分法(VAS)评分,首次治疗后即刻、治疗后7 d主诉总体疼痛、鼻部疼痛、眼部疼痛明显缓解(疼痛缓解程度≥50%)、鼻涕明显减少(鼻涕减少≥50%)的例数,接受治疗次数,满意度VAS评分,头晕、嗜睡等不良反应发生情况。结果治疗方法与治疗时间在总体疼痛、鼻部疼痛、眼部疼痛的VAS评分上存在交互作用(P<0.05);治疗方法和治疗时间在总体疼痛、鼻部疼痛、眼部疼痛的VAS评分上主效应显著(P<0.05)。A组患者治疗后4 d总体疼痛、眼部疼痛的VAS评分低于B组(P<0.05)。A组患者治疗后即刻、1、4、7 d总体疼痛、鼻部疼痛、眼部疼痛的VAS评分低于治疗前(P<0.05);B组患者治疗后4、7 d总体疼痛、鼻部疼痛、眼部疼痛的VAS评分低于治疗前、治疗后即刻(P<0.05)。A组患者治疗后即刻主诉总体疼痛、鼻部疼痛、眼部疼痛明显缓解例数多于B组(P<0.05);两组患者治疗后即刻主诉鼻涕明显减少,治疗后7 d主诉总体疼痛、鼻部疼痛、眼部疼痛明显缓解、鼻涕明显减少的例数比较,差异无统计学意义(P>0.05)。A组患者治疗后7 d主诉鼻涕明显减少例数多于治疗后即刻(P<0.05);B组患者治疗后7 d主诉总体疼痛、鼻部疼痛、眼部疼痛明显缓解、鼻涕明显减少的例数多于治疗后即刻(P<0.05)。A组患者接受治疗次数≥2次的患者多于B组(P<0.05)。A组患者满意度VAS评分高于B组(P<0.05)。两组患者无一例出现头晕、嗜睡等不良反应。结论 1%利多卡因浸润鼻腔黏膜是一种安全、有效的缓解急性上呼吸道感染相关性鼻内神经痛的治疗方法。
Objective To evaluate the clinical efficacy and safety of lidocaine infiltration nasal mucosa for treatment of intranasal neuralgia associated with acute upper respiratory tract infection. Methods From October 2014 to December 2015, 40 patients with intranasal neuralgia who were eligible for inclusion and exclusion criteria of acute upper respiratory tract infection were enrolled in Xuanwu Hospital of Capital Medical University. The patients were divided into lidocaine group (A group) and 0.9% sodium chloride solution group (B group) by random number table method, 20 cases in each group. Nasal mucosa of patients in group A and group B were infiltrated with cotton swab dipped with 1% lidocaine solution and 0.9% sodium chloride solution respectively for 3 ~ 5 min every time with a time interval of 1 ~ 3 min with a total infiltration of 5 to 10 times . The pain visual analogue scale (VAS) score of the patients before treatment and immediately after the first, the first, the seventh and seventh days after the treatment were recorded. The total pain, Nasal pain, eye pain was significantly relieved (pain relief ≥ 50%), a significant reduction in nasal discharge (nasal discharge was reduced by ≥ 50%) the number of cases, the number of treatment, satisfaction VAS score, dizziness, drowsiness and other adverse reactions. Results There was interaction between the treatment method and the treatment time on VAS scores of general pain, nasal pain and eye pain (P <0.05). The treatment methods and treatment time were significantly different on VAS score of total pain, nasal pain and eye pain The main effect was significant (P <0.05). Group A patients had general pain 4 days after treatment and VAS scores of eye pain were lower than those in group B (P <0.05). Immediately after treatment, the VAS scores of general pain, nasal pain and eye pain in group A were lower than those before treatment (P <0.05) on the 1st, 4th, and 7th day after treatment. The overall pain in group B at 4 and 7 days after treatment, VAS score of pain and eye pain was lower than before treatment and immediately after treatment (P <0.05). A group of patients complained immediately after treatment of general pain, nasal pain, eye pain relief significantly more cases than in group B (P <0.05); two groups of patients immediately after treatment, the main reduction of nasal discharge, 7 days after treatment of total complaints of pain, Nasal pain, eye pain was significantly alleviated, nasal discharge was significantly reduced in the number of cases, the difference was not statistically significant (P> 0.05). In group A, the number of patients with nasal drops significantly decreased on the 7th day after treatment (P <0.05), and the patients in group B complained of overall pain, nasal pain, eye pain and nasal drops significantly after 7 days of treatment More than immediately after treatment (P <0.05). Patients in group A received more than 2 treatments more than those in group B (P <0.05). The VAS scores of patients in group A were higher than those in group B (P <0.05). None of the patients in the two groups experienced dizziness, drowsiness and other adverse reactions. Conclusion 1% lidocaine infiltration nasal mucosa is a safe and effective treatment of acute upper respiratory tract infection associated with intranasal neuralgia.