胸脊神经背根神经节脉冲射频联合密集型银质针治疗胸背部带状疱疹后神经痛的疗效  

Efficacy of pulsed radiofrequency of thoracic spinal dorsal root ganglion combined with intensive silver needles in the treatment of postherpetic neuralgia on the chest and back

作　　者：熊志宏 李俊峰[1] 缪宜宏 岳梨蓉 Xiong Zhihong;Li Junfeng;Miao Yihong;Yue Lirong(Department of Pain Medicine,Affiliated Hospital of Yunnan University,Kunming City,Yunnan Province 650021,China;Department of General Internal Medicine,Affiliated Hospital of Yunnan Nationality University,Kunming City,Yunnan Province 650031,China)

机构地区：[1]云南大学附属医院疼痛科,昆明市650021 [2]云南民族大学医院普通内科,昆明市650031

出　　处：《中华疼痛学杂志》2022年第1期77-83,共7页Chinese Journal Of Painology

摘　　要：目的观察胸脊神经背根神经节脉冲射频术联合密集型银质针治疗胸背部带状疱疹后神经痛的临床疗效。方法收集2017年7月至2020年1月由云南大学附属医院疼痛科收治的159例胸背部带状疱疹后神经痛患者,采用随机数字表法分为3组(n=53):单纯口服药物组(A组),脉冲射频治疗组(B组),银质针治疗组(C组)。A组采用口服盐酸曲马多缓释片、加巴喷丁胶囊、甲钴胺片与艾司唑仑片。B组在A组治疗基础上给予相应胸脊神经背根神经节脉冲射频治疗,治疗参数为42℃,频率2 Hz,脉宽20 ms,电压26~56 V,治疗时间180 s,间隔15 s,连续两个周期;5 d后再以同样参数重复治疗1次,两次为1疗程。C组在B组基础上于射频治疗后1~2 d给予胸腰椎密集型银质针肌肉松解治疗,40~44℃,加热20 min;3 d后以同样方法再治疗1次。观察并比较3组患者治疗前、治疗后1 d、l、4及12周时的NRS评分、AIS评分,并记录3组患者治疗结束后12周时优效、良效、可效、无效的例数、优效率、总有效率及不良反应发生情况。结果3组患者治疗后NRS评分较治疗前均有下降,且差异均有统计学意义(P均<0.05)。治疗后12周时NRS评分B组(2.8±1.1)分、C组(1.0±0.5)分较A组的(4.2±1.3)分均下降(P均<0.05),C组下降更为显著。治疗后12周AIS评分B组(2.3±1.0)分、C组(0.8±0.3)分与A组(3.7±1.2)分比较均降低,且差异均有统计学意义(P均<0.05)。结论胸脊神经背根神经节脉冲射频术联合密集型银质针可有效治疗胸背部带状疱疹后神经痛。Objective To observe the clinical effects of pulsed radiofrequency of thoracic spinal dorsal root ganglion combined with intensive silver needles on the chest and back in the treatment of patients with postherpetic neuralgia.Methods One hundred and fifty-nine patients with postherpetic neuralgia on the chest and back in the Department of Pain Medicine of the Affiliated Hospital of Yunnan University from July 2017 to January 2020 were collected and randomly divided into 3 groups(n=53 each):oral medication group(group A),pulsed radiofrequency group(group B)and silver needle group(group C).The patients were treated by oral medication of tramadol hydrochloride,gabapentin capsules,mecobalamin tablets and estazolam tablets in group A,by pulsed radiofrequency of thoracic spinal dorsal root ganglion at the basis of group A in group B,with parameters of temperature 42℃,frequency 2 Hz,pulse width 20 ms,voltage 26-56 V,180 seconds two cycles,and repeated 3 days later.And at the bases treatment of group B,the patients were treated by silver needle on the chest and back at 1-2 days after the radiofrequency therapy in group C,with the needle temperature 42-44℃for 20 minutes,and one more treatment if the patient still had partial tension in the erector spinal muscles after 3 days.NRS and AIS were observed before the treatment and 1 day,4 weeks,8 weeks and 12 weeks after the treatment.The effects of excellent,good,poor and ineffective effects were recorded at 12 weeks after the treatment.Adverse reactions were also recorded in the three groups.Results The NRS were decreased in the three groups after the treatment compared with those before the treatment.At 12 weeks after the treatment,NRS was[(2.8±1.1)and(1.0±0.5)]in group B and group C respectively,and significantly lower than those in group A(4.2±1.3)(all P<0.05),the NRS in group C were lowest among the three groups(P<0.05).AIS were[(2.3±1.0)and(0.8±0.3)]respectively in group B and group C at 12 weeks after the treatment,which were significantly improved compared with

关 键 词：背根神经节 脉冲射频 带状疱疹后神经痛 银质针 

分 类 号：R752.12[医药卫生—皮肤病学与性病学]