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一图读懂：带状疱疹后神经疼痛

2022-03-10 网络 网络

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带状疱疹后神经疼痛诊断思路病毒抗体的存在有助于确诊带状疱疹亚临床感染，特别是在发生无疱型带状疱疹的情况下 免疫过氧化物酶染色、组织病理学和 Tzanck 细胞学检查等其他检查有助于确定带状疱疹感染

带状疱疹后神经疼痛诊断思路

一、病史问询

起病和病程

分散和局部皮肤的疼痛，常表现为某神经分布相关区域内瘙痒性、灼烧性、针刺样、刀割样、电击样或搏动样疼痛

间歇性和慢性疼痛

有明确记录的疱疹史

情感及睡眠情况

日常生活能力改变

重要的个人史

二、体格检查

可见局部有遗留的瘢痕或色素沉着

局部可有痛觉过敏或痛觉减退

局部可有痛觉超敏

局部可有汗多等自主神经功能紊乱的表现

三、实验室检查

带状疱疹后疼痛的诊断不依赖于特殊的实验室检查 

病毒培养和免疫荧光染色法可用于鉴别单纯疱疹和带状疱疹 

病毒抗体的存在有助于确诊带状疱疹亚临床感染，特别是在发生无疱型带状疱疹的情况下 免疫过氧化物酶染色、组织病理学和 Tzanck 细胞学检查等其他检查有助于确定带状疱疹感染

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1205943, encodeId=d9eb12059438c, content=简直是人到老年的梦魇啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=38836545012, createdName=ms9000001021399430, createdTime=Fri Mar 25 19:57:25 CST 2022, time=2022-03-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1580493, encodeId=e846158049317, content=<a href='/topic/show?id=c026e05485f' target=_blank style='color:#2F92EE;'>#疱疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, 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=Sat Mar 12 00:39:16 CST 2022, time=2022-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1201395, encodeId=a92112013950d, content=为啥不研究清除病毒的药物？, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5ee85626223, createdName=ms8000001203784851, createdTime=Thu Mar 10 15:14:42 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1201227, encodeId=9b32120122e75, content=<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201225/ad2f9bec445f4a65920cb05c5a0a8452/e4346fc83e4a4efab3aa50b37eacff5e.jpg, createdBy=bef75416446, createdName=不能空腹吃早餐, createdTime=Thu Mar 10 11:53:45 CST 2022, time=2022-03-10, status=1, ipAttribution=)]
    2022-03-25 ms9000001021399430

    简直是人到老年的梦魇啊

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1205943, encodeId=d9eb12059438c, content=简直是人到老年的梦魇啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=38836545012, createdName=ms9000001021399430, createdTime=Fri Mar 25 19:57:25 CST 2022, time=2022-03-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1580493, encodeId=e846158049317, content=<a href='/topic/show?id=c026e05485f' target=_blank style='color:#2F92EE;'>#疱疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, 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=Sat Mar 12 00:39:16 CST 2022, time=2022-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1201395, encodeId=a92112013950d, content=为啥不研究清除病毒的药物？, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5ee85626223, createdName=ms8000001203784851, createdTime=Thu Mar 10 15:14:42 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1201227, encodeId=9b32120122e75, content=<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201225/ad2f9bec445f4a65920cb05c5a0a8452/e4346fc83e4a4efab3aa50b37eacff5e.jpg, createdBy=bef75416446, createdName=不能空腹吃早餐, createdTime=Thu Mar 10 11:53:45 CST 2022, time=2022-03-10, status=1, ipAttribution=)]
    2022-03-12 ms2694732865965676

    #疱疹#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1205943, encodeId=d9eb12059438c, content=简直是人到老年的梦魇啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=38836545012, createdName=ms9000001021399430, createdTime=Fri Mar 25 19:57:25 CST 2022, time=2022-03-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1580493, encodeId=e846158049317, content=<a href='/topic/show?id=c026e05485f' target=_blank style='color:#2F92EE;'>#疱疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, 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=Sat Mar 12 00:39:16 CST 2022, time=2022-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1201395, encodeId=a92112013950d, content=为啥不研究清除病毒的药物？, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5ee85626223, createdName=ms8000001203784851, createdTime=Thu Mar 10 15:14:42 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1201227, encodeId=9b32120122e75, content=<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201225/ad2f9bec445f4a65920cb05c5a0a8452/e4346fc83e4a4efab3aa50b37eacff5e.jpg, createdBy=bef75416446, createdName=不能空腹吃早餐, createdTime=Thu Mar 10 11:53:45 CST 2022, time=2022-03-10, status=1, ipAttribution=)]
    2022-03-10 ms8000001203784851

    为啥不研究清除病毒的药物？

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1205943, encodeId=d9eb12059438c, content=简直是人到老年的梦魇啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=38836545012, createdName=ms9000001021399430, createdTime=Fri Mar 25 19:57:25 CST 2022, time=2022-03-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1580493, encodeId=e846158049317, content=<a href='/topic/show?id=c026e05485f' target=_blank style='color:#2F92EE;'>#疱疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, 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=Sat Mar 12 00:39:16 CST 2022, time=2022-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1201395, encodeId=a92112013950d, content=为啥不研究清除病毒的药物？, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5ee85626223, createdName=ms8000001203784851, createdTime=Thu Mar 10 15:14:42 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1201227, encodeId=9b32120122e75, content=<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201225/ad2f9bec445f4a65920cb05c5a0a8452/e4346fc83e4a4efab3aa50b37eacff5e.jpg, createdBy=bef75416446, createdName=不能空腹吃早餐, createdTime=Thu Mar 10 11:53:45 CST 2022, time=2022-03-10, status=1, ipAttribution=)]
    2022-03-10 不能空腹吃早餐

    #学习#学习一下

    0

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