脉冲射频联合高能量激光或皮内注射治疗带状疱疹后神经痛的疗效观察  

Efficacy of pulsed radio frequency combined with high intensity laser therapy or intradermal injection in the treatment of postherpetic neuralgia

作　　者：季云晶 孙悦 刘尧 汪婷 吴征元 申文 JI Yun-Jing;SUN Yue;LIU Yao;WANG Ting;WU Zheng-Yuan;SHEN Wen(The Key Laboratory of Anesthesiology,Xuzhou Medical University,Xuzhou 221004,China;Department of Pain Management,The Third People's Hospital of Wuxi,Wuxi 214000,China;Department of Pain Management,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]江苏省徐州医科大学麻醉学重点实验室,徐州221004 [2]无锡市第三人民医院疼痛科,无锡214000 [3]徐州医科大学附属医院疼痛科,徐州221002

出　　处：《中国疼痛医学杂志》2020年第9期668-674,679,共8页Chinese Journal of Pain Medicine

基　　金：国家自然科学基金面上项目(81571066)。

摘　　要：目的:在超声引导下脉冲射频(pulsed radiofrequency, PRF)的基础上,比较高能量激光(high intensity laser therapy, HILT)和皮内注射治疗带状疱疹后神经痛(postherpetic neuralgia, PHN)疗效。方法:选取2019年2月至9月我科120例胸背部PHN病人,随机分为脉冲射频组(A组)、脉冲射频联合高能量激光组(B组)、脉冲射频联合皮内注射组(C组),每组40例。记录治疗前、治疗后1周、1月、3月自发性疼痛及触诱发痛的视觉模拟评分法(visual analogue scale, VAS)评分、睡眠质量评分(self-rating scale of sleep, SRSS)、治疗后病人满意度、治疗前及治疗后各时间点的医院焦虑抑郁量表评分(hospital anxiety and depression scale, HADS)、简式Mc Gill疼痛评分(short-form of McGill pain questionnaire, SF-MPQ)、平均每日加巴喷丁使用量、盐酸曲马多使用率及不良反应发生率。结果:与治疗前相比,3组治疗后各时间点的自发性疼痛及触诱发痛的VAS和SRSS评分均降低(P <0.05);与A组相比,B、C组治疗后1周、1月的自发性疼痛VAS和SRSS评分均降低(P <0.05),治疗后各时间点触诱发痛VAS、HADS和SF-MPQ评分以及加巴喷丁使用量均降低(P <0.05);B、C组各时间点的VAS、SRSS、HADS和SF-MPQ评分以及加巴喷丁使用量无明显差异(P> 0.05);3组盐酸曲马多使用率无明显差异(P> 0.05);B组病人满意度高于A、C组(P <0.05);B、C组不良反应发生率低于A组(P <0.05)。结论:超声引导下PRF联合HILT或皮内注射较单独PRF治疗能更好地改善PHN病人的疼痛。Objective:The aim of this study was to compare the efficacy of high intensity laser therapy(HILT)combined with ultrasound-guided parathoracic nerve pulsed radio frequency(PRF)and intradermal injection in patients with postherpetic neuralgia(PHN).Methods:One hundred and twenty patients diagnosed with thoracic postherpetic neuralgia and over 60 years of age were randomly assigned to the control group A(n=40),the test group B(n=40),and the test group C(n=40).All groups were treated with conventional drug and received ultrasound-guided thoracic spinal nerve pulsed radiofrequency(USG-PRF).High intensity laser therapy was set on the basis of drug therapy and USG-PRF in group B.Intradermal injection was set on the basis of drug therapy and USG-PRF in group C.The curative effect was evaluated at 1 week,1 month,3 months and after the end of the treatment cycle(referred to as post-treatment)by visual analogue scale(VAS),self-rating scale of sleep(SRSS),patients'satisfaction,hospital anxiety and depression scale(HADS),short-form of McGill pain questionnaire(SF-MPQ),the average daily dose of gabapentin,and the proportion of patients consuming tramadol hydrochloride.The adverse reactions were also recorded in three groups.Results:VAS and SRSS in all groups were significantly decreased at different post-treatment time points compared with pre-treatment scores(P<0.05).Compared to group A,group B and group C showed significantly lower post-treatment VAS score of spontaneous pain and SRSS at 1 week and 1 month after the treatments(P<0.05),but no significant difference in scores at 3 months(P>0.05).Group B and group C showed significantly lower scores of tactile-induced pain at 1 week,1 month and 3 months compared to group A(P<0.05).Group B and group C showed significantly lower HADS and SF-MPQ score at 1 week,1 month and 3 months compared to group A(P<0.05).The average daily dose of gabapentin were significantly lower in group B and group C compared to group A(P<0.05).No significant difference in the proportion of patients consum

关 键 词：带状疱疹后神经痛 脉冲射频 高能量激光 皮内注射 触诱发痛 

分 类 号：R752.12[医药卫生—皮肤病学与性病学]