原发性面肌痉挛采用高电压长时程脉冲射频术治疗的疗效  

Efficacy of high-voltage and long-duration pulsed radiofrequency therapy in the treatment of patients with primary hemifacial spasm

作　　者：李丽梅[1] 刘晓东[2] 张志利[1] Li Limei;Liu Xiaodong;Zhang Zhili(Department of Pain Management,the First Hospital of Qinhuangdao City,Qinhuangdao City,Hebei Province 066000,China;Department of Ultrosound Diagnosis,the First Hospital of Qinhuangdao City,Qinhuangdao City,Hebei Province 066000,China)

机构地区：[1]秦皇岛市第一医院疼痛科,066000 [2]秦皇岛市第一医院超声诊断科,066000

出　　处：《中华疼痛学杂志》2021年第6期614-620,共7页Chinese Journal Of Painology

摘　　要：目的探讨高电压长时程脉冲射频治疗原发性面肌痉挛的有效性及安全性。方法收集2015年2月至2019年2月于秦皇岛市第一医院疼痛科收治的原发性面肌痉挛患者56例,性别、年龄不限,病史2个月~20年,根据随机数字表法分为高电压长时程脉冲射频组(PRF组)和神经阻滞组(NB组),每组28例。PRF组采用茎乳孔区面神经高电压长时程脉冲射频治疗(2 Hz、20 ms),初始脉冲射频场强为40 V,治疗温度42℃,逐渐增加至患者可耐受的最大场强直至960 s,再推注神经消炎液3 ml(2%盐酸利多卡因1 ml,复方倍他米松磷酸钠0.5 ml,甲钴胺溶液0.5 mg加生理盐水稀释至3 ml)结束。NB组采用面神经阻滞和星状神经节阻滞,面神经阻滞给予消炎镇痛液3 ml,每5日注射1次,共3次;星状神经节阻滞给予含甲钴胺0.5 mg的0.5%利多卡因共8 ml,每日阻滞1次,左右交替各5次。记录治疗前及治疗后15 d、1个月、3个月、6个月时Cohen分级,并计算治愈率;记录治疗前及治疗后6个月时生活质量评分(SF-36)、复发率及不良反应发生情况。结果两组患者一般情况比较差异无统计学意义(P均>0.05);与NB组比较,PRF组治疗后15 d、1个月、3个月、6个月Cohen分级明显降低,治愈率分别为96%、93%、86%、79%,NB组相同时点治愈率为54%、39%、32%、25%,PRF组治愈率均高于NB组(P均<0.05);两组治疗后6个月SF-36评分较治疗前均提高(P均<0.05),但PRF组一般健康状况及心理健康总测量指标明显高于NB组(P均<0.05),且复发率明显低于NB组(P<0.05)。两组治疗过程中均未见局部感染、周围血肿、神经损害等并发症发生。结论高电压长时程脉冲射频术对原发性面肌痉挛有较好的治疗效果,明显提高患者的生活质量,可安全用于临床。Objective To observe the clinical efficacy and safety of high-voltage and long-duration pulsed radiofrequency on facial nerve in the treatment of patients with primary hemifacial spasm(HFS).Methods Fifty-six patients with primary HFS treated in Pain Management,the First Hospital of Qinhuangdao City from February 2015 to February 2019,regardless of sex and age,with the diseased course of 2 months to 20 years,were randomly collected in this study.Patients were divided by random number table into two groups:pulsed radiofrequency group(group PRF)and nerve block group(group NB),28 cases in each group.In group PRF,high-voltage and long-duration PRF was performed on facial nerve through stylomastoid foramen.The PRF mode with the basic settings of 42℃,2 Hz,20 ms,and 960 seconds was used.The initial electric voltage was 40 V,and then the voltage gradually increased until the patients could not tolerate the abnormal sensations.All patients tolerated maximal voltage(70-90 V)for 960 seconds,then a mixed solution 3 ml(2%lidocaine hydrochloride 1 ml,compound betamethasone 0.5 ml,mecobalamin 0.5 mg,diluted to 3 ml with normal saline)was injected.In group NB,facial nerve block with the mixed solution 3 ml was performed at stylomastoid foramen once every 5 days,3 times in total;the stellate ganglion block was performed with 0.5% lidocaine 8 ml on the right and left side alternately once a day,5 times on each side.The Cohen score classification before and 15 days,1 month,3 months,6 months after the treatment and SF-36 before and 6 months after the treatment were recorded;the cure rate,recurrence rate,and adverse reactions after the treatment were also recorded respectively.Results There were no differences in general conditions between the two groups(all P>0.05).Compared with group NB,the Cohen score classification in group PRF was significantly decreased at 15 days,1 month,3 months,6 months after the treatment.The cure rate was 96%,93%,86%,79% respectively in group PRF,compared with 54%,39%,32%,25% respectively in group NB,with

关 键 词：脉冲射频 面神经疾病 神经传导阻滞 面神经 星状神经节 面肌痉挛 

分 类 号：R651.3[医药卫生—外科学]