重复经颅磁刺激联合加巴喷丁治疗三叉神经射频热凝术后复发痛的效果  

Efficacy of repetitive transcranial magnetic stimulation combined with gabapentin for treatment of recurrent pain after trigeminal radiofrequency thermocoagulation

作　　者：李娜[1] 袁蓉[2] 贾绍芳[1] 公维义[1] 马淑敏[1] 马玲[3] 倪家骧[1] 

机构地区：[1]首都医科大学宣武医院疼痛诊疗中心,北京市100053 [2]兵器工业北京北方医院超声科,100089 [3]大庆油田总医院麻醉疼痛科,163001

出　　处：《中华麻醉学杂志》2017年第5期520-523,共4页Chinese Journal of Anesthesiology

摘　　要：目的 评价重复经颅磁刺激（rTMS）联合加巴喷丁治疗三叉神经射频热凝术后复发痛的效果。方法 拒绝手术治疗的三叉神经射频热凝术后复发痛患者40例，性别不限，年龄45～80岁，ASA分级Ⅰ或Ⅱ级，VAS评分≥4分，复发病程0.5～17.0个月，采用随机数字表法分为2组（n＝20）：加巴喷丁组（A组）和加巴喷丁＋rTMS组（B组）。B组共接受2个疗程rTMS治疗，5 d为1个疗程，1次/d，间隔2 d进行第2个疗程。记录治疗后6个月内镇痛有效、主观疼痛缓解情况，采用改良Macnab标准评价疗效。记录加巴喷丁日用量及rTMS治疗相关和加巴喷丁相关不良反应发生情况。结果 B组未见rTMS治疗相关不良反应发生。与A组比较，B组镇痛有效率和主观疼痛缓解率升高，疗效增强，加巴喷丁日用量降低，加巴喷丁相关不良反应发生率降低（P〈0.05）。结论 rTMS联合加巴喷丁治疗三叉神经射频热凝术后复发痛的效果优于单独加巴喷丁治疗，且安全性良好。Objective To evaluate the efficacy of repetitive transcranial magnetic stimulation（rTMS）combined with gabapentin for treatment of recurrent pain after trigeminal radiofrequency thermocoagulation.Methods Forty patients of both sexes suffering from recurrent pain after trigeminal radiofrequency thermocoagulation, who refused surgical treatment, aged 45-80 yr, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, with visual analog scale score≥4, with the course of recurrent pain 0.5-17.0 months, were randomized into 2 groups（n=20 each）using a random number table： gabapentin group（group A）and gabapentin plus rTMS group（group B）. The patients were treated with 2 courses of rTMS in total（5 days for 1 course, 1 time per day）and with the second course at a 2-day interval in group B. Effective analgesia and pain relief were recorded within 6 months after treatment, and the therapeutic efficacy was evaluated according to the modified Macnab criteria.The daily consumption of gabapentin and development of rTMS- and gabapentin-related adverse reactions were recorded.Results No rTMS-related adverse reactions were found in group B. Compared with group A, the rates of effective analgesia and pain relief were significantly increased, the therapeutic efficacy was enhanced, the daily consumption of gabapentin was decreased, and the incidence of gabapentin-related adverse reactions was decreased in group B（P〈0.05）.Conclusion Combination of rTMS and gabapentin produces better efficacy than gabapentin alone when used to treat the recurrent pain after trigeminal radiofrequency thermocoagulation, and the safety is good.

关 键 词：经颅磁刺激 环己酸类 导管消融术 三叉神经痛 

分 类 号：R745.11[医药卫生—神经病学与精神病学]