化学性胸交感神经调制术联合脉冲射频术对上肢带状疱疹后遗神经痛的疗效  

Efficacy of chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequency in treating upper limb postherpetic neuralgia

作　　者：谢可越 刘倩影 安康 黄冰[1] 姚明[1] 孙延豹[2] 马建兵[2] 祝则峰[2] Xie Keyue;Liu Qianying;An Kang;Huang Bing;Yao Ming;Sun Yanbao;Ma Jianbing;Zhu Zefeng(Department of Anesthesiology and Pain Medical Center,First Affiliated Hospital of Jiaxing,Jiaxing 314001,China;Department of Radiology,First Affiliated Hospital of Jiaxing,Jiaxing 314001,China;Department of Anesthesiology,Bengbu Medical College,Bengbu 233000,China)

机构地区：[1]嘉兴学院附属第一医院麻醉与疼痛医学中心,314001 [2]嘉兴学院附属第一医院放射科,314001 [3]蚌埠医学院麻醉系,233000

出　　处：《中华麻醉学杂志》2018年第8期929-932,共4页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金(81341035,2013,90,0127);浙江省自然科学基金(LY16H090016,LY17H090019);浙江省医药卫生科技计划一般项目(2015KYA217);浙江省医药卫生平台重点课题(2016ZDA018);嘉兴市科技厅项目(2017BY18001).

摘　　要：目的 评价化学性胸交感神经调制术联合脉冲射频术对上肢带状疱疹后遗神经痛(PHN)的疗效.方法 上肢PHN患者42例,年龄48~75岁,采用数字随机表法分为2组(n=21):化学性胸交感神经调制术联合脉冲射频术组(TSNM+PR组)和脉冲射频术组(PR组).TSNM+PR组采用化学性胸交感神经调制术联合脉冲射频术治疗,PR组采用单纯脉冲射频治术疗.记录治疗相关不良反应发生情况.于术前及术后1 d、1和3个月时记录数字评分法(NRS)评分,并进行疗效分级.记录术后3个月治疗有效情况和疼痛复发情况.于术前及术后1d、1和3个月时进行感觉神经定量测试,记录电流感觉阈值.结果 与PR组比较,TSNM+PR组术后1和3个月NRS评分降低,疗效增强,治疗有效率升高,疼痛复发率降低,患侧术后1和3个月时250和5 Hz下电流感觉阈值升高(P<0.05).2组均未见治疗相关不良反应发生.结论 化学性胸交感神经调制术联合脉冲射频术对上肢PHN疗效确切,且安全性较高.Objective To evaluate the efficacy of chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequency in treating upper limb postherpetic neuralgia ( PHN). Methods Forty-two patients of both sexes with upper limb PHN, aged 48-75 yr, were divided into 2 groups ( n=21 each) using a random number table method: chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequency group ( TSNM+PR group) and pulsed radiofrequency group ( PR group) . TSNM+PR group was treated using chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequen-cy, and PR group received pulsed radiofrequency alone. The occurrence of treatment-related adverse reac-tions was recorded. Numeric rating scale scores were recorded preoperatively and at 1 day and 1 and 3 months after operation, and the efficacy was graded. The effective treatment and pain recurrence were re-corded 3 months after operation. Quantitative sensory nerve tests were performed to record the current per-ception threshold before operation and on 1 day, 1 month and 3 months after operation. Results Compared with PR group, numeric rating scale score was significantly decreased, the therapeutic effect was en-hanced, the rate of effective treatment was increased, the recurrence rate of pain was decreased at 1 and 3 months after surgery, the current perception threshold at 250 and 5 Hz on the ipsilateral side was increased at 1 and 3 months after surgery in TSNM+PR group ( P<0. 05) . No treatment-related adverse reactions were found in two groups. Conclusion Chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequency provides reliable therapeutic effect and higher safety for upper limb PHN.

关 键 词：神经痛 带状疱疹后 四肢 交感神经切除术 化学 导管消融术 

分 类 号：R752.12[医药卫生—皮肤病学与性病学]