Baidu
map

土耳其,新冠疫苗注射后出现带状疱疹,肉毒毒素可以缓解神经痛

2021-08-31 L 肉毒毒素btxa

带状疱疹后神经痛以药物治疗为基础,随着研究的深入,由于肉毒毒素局部注射治疗带状疱疹后神经痛安全有效且不良反应低,越来越得到关注。

新冠病毒的可怕之处,除了对70岁以上的老人,以及肺病和肥胖症等合并医疗状况的人不友好之外,它的无数临床表现而令医学界大吃一惊。自然COVID-19感染引起的皮肤症状包括弥漫性红斑爆发、广泛麻疹和水痘状囊泡等。

国外的疫苗主要有三种,即FDA批准的现代疫苗和辉瑞疫苗以及最近新批的强生疫苗,这些疫苗注射后也会有各种各样的并发症。笔者也科普过不少,感兴趣的医生们可以去后台搜索。

2021年2月5日,拉斯维加斯皮肤科诊所发现首例与COVID-19疫苗相关的水痘-带状疱疹病毒感染后带状疱疹爆发。自最初的患者以来,拉斯维加斯皮肤科诊所共发现另外5例COVID-19疫苗相关病例。另有14例病例已报告给我们,并通过社交媒体通过病史和照片得到确认,平均发病时间为6.85天,为带状疱疹的最初体征/症状(见表1)。然而,在文献中,仅土耳其报告了一例新冠疫苗注射后出现带状疱疹的病例。

我们来看其中几例。

案例一

一名77岁,有银屑病史,患有甲氨蝶酯,克罗恩病的患者,并治疗过曲霉肿的男性患者,他的右中腹、右侧和右中背部区域出现了严重疼痛、单侧皮肤疱疹爆发。这些症状是在他注射了第一剂现代疫苗两天后出现的,根据他的疾病的自然过程,最初的疼痛恶化为严重疼痛4天后完全爆发(见下图)。病人被临床诊断为带状疱疹病毒感染,并用伐昔洛韦治疗病毒,此外口服加巴彭汀,氧可酮,和局部使用4%的利多卡因止痛。尽管在初始接种疫苗后爆发了带状疱疹,但患者仍被建议接受第二剂现代疫苗。

案例二

一名65岁男性,在发病前35年有带状疱疹病史,长期高血压,因疼痛、红斑和聚集性皮肤发疹而接受咨询。症状开始于他第二次注射辉瑞疫苗后,在接种后14天出现瘙痒,随后在瘙痒后3天出现胸痛和背痛加剧。患者被诊断为带状疱疹病毒感染,随后接受了一个疗程的伐昔洛韦治疗病毒,口服加巴喷丁和局部4%利多卡因治疗疼痛。

肉毒毒素注射缓解带状疱疹后神经痛

带状疱疹后神经痛以药物治疗为基础,国内专家共识推荐治疗的一线药物包括钙离子通道调节剂(普瑞巴林和加巴喷丁)、三环类抗抑郁药(阿米替林)和5%利多卡因贴剂,二线药物包括阿片类药物和曲马多。非药物治疗主要包括神经阻滞、选择性神经毁损、鞘内药物输注治疗、神经调控治疗等。随着研究的深入,由于肉毒毒素局部注射治疗带状疱疹后神经痛安全有效且不良反应低,越来越得到关注。

注射方案如下:一般配制药物浓度为2.5~5U/0.1mL。根据皮损和感觉异常的部位选择受累区域行多点皮下注射,有文献报道予以皮内注射,但疗效持续时间较短。每点注射剂量2.5~5.0U,皮肤表面间隔1~2cm,在皮损愈合后进行治疗(见下图)。

一般注射后7天后起效,可明显减少疼痛及减少阿片类药物使用,疗效维持3~4月不等时间。

肉毒毒素治疗带状疱疹后神经痛不良反应发生率极低。可能出现局部肌肉发僵感、注射部位水肿、淤血等;一般为可逆性,通常1-3周内自行缓解,无需特殊处理。长期口服抗凝、抗血小板聚集药物者,建议短期停用后注射;皮肤下组织松弛者,需延长注射后压迫时间,有助于避免发生出血、瘀斑。对于胸部带状疱疹后神经痛局部注射治疗者,应注意避免穿刺过深,以免损伤胸腔。

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1723344, encodeId=aa0b1e23344c3, content=<a href='/topic/show?id=9ac04125417' target=_blank style='color:#2F92EE;'>#土耳其#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=41254, encryptionId=9ac04125417, topicName=土耳其)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=581b33444961, createdName=aliceclz, createdTime=Sat Feb 05 20:49:26 CST 2022, time=2022-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1318552, encodeId=597f13185525b, content=<a href='/topic/show?id=47ae808583c' target=_blank style='color:#2F92EE;'>#肉毒毒素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80858, encryptionId=47ae808583c, topicName=肉毒毒素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c8f4467, createdName=AspirantSuo, createdTime=Thu Sep 02 01:49:26 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540840, encodeId=20001540840ad, content=<a href='/topic/show?id=ac8de440615' target=_blank style='color:#2F92EE;'>#神经痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74406, encryptionId=ac8de440615, topicName=神经痛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d8213287489, createdName=贵阳, createdTime=Thu Sep 02 01:49:26 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1580469, encodeId=f05c15804699d, content=<a href='/topic/show?id=c026e05485f' target=_blank style='color:#2F92EE;'>#疱疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70548, encryptionId=c026e05485f, topicName=疱疹)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2dcf16628144, createdName=ms2694732865965676, createdTime=Thu Sep 02 01:49:26 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1029919, encodeId=1d071029919dc, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Tue Aug 31 13:49:26 CST 2021, time=2021-08-31, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1723344, encodeId=aa0b1e23344c3, content=<a href='/topic/show?id=9ac04125417' target=_blank style='color:#2F92EE;'>#土耳其#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=41254, encryptionId=9ac04125417, topicName=土耳其)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=581b33444961, createdName=aliceclz, createdTime=Sat Feb 05 20:49:26 CST 2022, time=2022-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1318552, encodeId=597f13185525b, content=<a href='/topic/show?id=47ae808583c' target=_blank style='color:#2F92EE;'>#肉毒毒素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80858, encryptionId=47ae808583c, topicName=肉毒毒素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c8f4467, createdName=AspirantSuo, createdTime=Thu Sep 02 01:49:26 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540840, encodeId=20001540840ad, content=<a href='/topic/show?id=ac8de440615' target=_blank style='color:#2F92EE;'>#神经痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74406, encryptionId=ac8de440615, topicName=神经痛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d8213287489, createdName=贵阳, createdTime=Thu Sep 02 01:49:26 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1580469, encodeId=f05c15804699d, content=<a href='/topic/show?id=c026e05485f' target=_blank style='color:#2F92EE;'>#疱疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70548, encryptionId=c026e05485f, topicName=疱疹)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2dcf16628144, createdName=ms2694732865965676, createdTime=Thu Sep 02 01:49:26 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1029919, encodeId=1d071029919dc, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Tue Aug 31 13:49:26 CST 2021, time=2021-08-31, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1723344, encodeId=aa0b1e23344c3, content=<a href='/topic/show?id=9ac04125417' target=_blank style='color:#2F92EE;'>#土耳其#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=41254, encryptionId=9ac04125417, topicName=土耳其)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=581b33444961, createdName=aliceclz, createdTime=Sat Feb 05 20:49:26 CST 2022, time=2022-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1318552, encodeId=597f13185525b, content=<a href='/topic/show?id=47ae808583c' target=_blank style='color:#2F92EE;'>#肉毒毒素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80858, encryptionId=47ae808583c, topicName=肉毒毒素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c8f4467, createdName=AspirantSuo, createdTime=Thu Sep 02 01:49:26 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540840, encodeId=20001540840ad, content=<a href='/topic/show?id=ac8de440615' target=_blank style='color:#2F92EE;'>#神经痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74406, encryptionId=ac8de440615, topicName=神经痛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d8213287489, createdName=贵阳, createdTime=Thu Sep 02 01:49:26 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1580469, encodeId=f05c15804699d, content=<a href='/topic/show?id=c026e05485f' target=_blank style='color:#2F92EE;'>#疱疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70548, encryptionId=c026e05485f, topicName=疱疹)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2dcf16628144, createdName=ms2694732865965676, createdTime=Thu Sep 02 01:49:26 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1029919, encodeId=1d071029919dc, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Tue Aug 31 13:49:26 CST 2021, time=2021-08-31, status=1, ipAttribution=)]
    2021-09-02 贵阳
  4. [GetPortalCommentsPageByObjectIdResponse(id=1723344, encodeId=aa0b1e23344c3, content=<a href='/topic/show?id=9ac04125417' target=_blank style='color:#2F92EE;'>#土耳其#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=41254, encryptionId=9ac04125417, topicName=土耳其)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=581b33444961, createdName=aliceclz, createdTime=Sat Feb 05 20:49:26 CST 2022, time=2022-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1318552, encodeId=597f13185525b, content=<a href='/topic/show?id=47ae808583c' target=_blank style='color:#2F92EE;'>#肉毒毒素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80858, encryptionId=47ae808583c, topicName=肉毒毒素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c8f4467, createdName=AspirantSuo, createdTime=Thu Sep 02 01:49:26 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540840, encodeId=20001540840ad, content=<a href='/topic/show?id=ac8de440615' target=_blank style='color:#2F92EE;'>#神经痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74406, encryptionId=ac8de440615, topicName=神经痛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d8213287489, createdName=贵阳, createdTime=Thu Sep 02 01:49:26 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1580469, encodeId=f05c15804699d, content=<a href='/topic/show?id=c026e05485f' target=_blank style='color:#2F92EE;'>#疱疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70548, encryptionId=c026e05485f, topicName=疱疹)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2dcf16628144, createdName=ms2694732865965676, createdTime=Thu Sep 02 01:49:26 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1029919, encodeId=1d071029919dc, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Tue Aug 31 13:49:26 CST 2021, time=2021-08-31, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1723344, encodeId=aa0b1e23344c3, content=<a href='/topic/show?id=9ac04125417' target=_blank style='color:#2F92EE;'>#土耳其#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=41254, encryptionId=9ac04125417, topicName=土耳其)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=581b33444961, createdName=aliceclz, createdTime=Sat Feb 05 20:49:26 CST 2022, time=2022-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1318552, encodeId=597f13185525b, content=<a href='/topic/show?id=47ae808583c' target=_blank style='color:#2F92EE;'>#肉毒毒素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80858, encryptionId=47ae808583c, topicName=肉毒毒素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c8f4467, createdName=AspirantSuo, createdTime=Thu Sep 02 01:49:26 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1540840, encodeId=20001540840ad, content=<a href='/topic/show?id=ac8de440615' target=_blank style='color:#2F92EE;'>#神经痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74406, encryptionId=ac8de440615, topicName=神经痛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0d8213287489, createdName=贵阳, createdTime=Thu Sep 02 01:49:26 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1580469, encodeId=f05c15804699d, content=<a href='/topic/show?id=c026e05485f' target=_blank style='color:#2F92EE;'>#疱疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70548, encryptionId=c026e05485f, topicName=疱疹)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2dcf16628144, createdName=ms2694732865965676, createdTime=Thu Sep 02 01:49:26 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1029919, encodeId=1d071029919dc, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Tue Aug 31 13:49:26 CST 2021, time=2021-08-31, status=1, ipAttribution=)]
    2021-08-31 公卫新人

    新冠肺炎,疫情何时才能消失

    0

Baidu
map
Baidu
map
Baidu
map