不同置管部位短时程脊髓电刺激治疗颈胸段带状疱疹相关性疼痛的疗效比较  

Comparing the effects of short-term spinal cord stimulation at different catheterization sites on the treatment of patients with cervicothoracic zoster-associated pain

作　　者：吴逸伦 胡鑫 赵鹏[1] 黄恒艺 叶小龙[1] 耿泽阳 许圣荣[1] 周增华[1] 何睿林[1] 蒋宗滨[1] Wu Yilun;Hu Xin;Zhao Peng;Huang Hengyi;Ye Xiaolong;Geng Zeyang;Xu Shengrong;Zhou Zenghua;He Ruilin;Jiang Zongbin(Department of Painology,the Second Affiliated Hospital of Guangxi Medical University,Nanning City,Guangxi Zhuang Autonomous Region 530007,China)

机构地区：[1]广西医科大学第二附属医院疼痛科,广西南宁市530007

出　　处：《中华疼痛学杂志》2022年第2期180-187,共8页Chinese Journal Of Painology

基　　金：国家自然科学基金培育基金(GJPY2018002);广西壮族自治区中医药管理局基金(GXZYZ 20210401)。

摘　　要：目的探讨不同置管部位短时程脊髓电刺激治疗颈胸段带状疱疹相关性疼痛的疗效比较。方法收集广西医科大学第二附属医院疼痛科2020年10月至2021年7月带状疱疹相关性疼痛(ZAP)51例患者,年龄36~98岁,性别不限,按植入电极不同部位分为背根神经电刺激(DNRS)组和脊髓背柱电刺激(DCS)组,DNRS组25例,DCS组26例,均采用频率小于300 Hz,脉宽60~360μs的低频电脉冲模式,电压根据患者主诉调节。于患者术前(T0)及术后1 d(T1)、3 d(T2)、7 d(T3)、1个月(T4)、2个月(T5)、3个月(T6)时采用数字等级评分法(NRS)、睡眠质量评分(QS)、总有效率对患者的临床疗效进行评估,于患者术前(T0)、术后1个月(T4)采用医院焦虑抑郁量表(HADS)评估患者的焦虑抑郁程度,并记录术后患者电极程控次数,进行疗效评定和分析。结果与T0相比,两种术式T1~T6时患者的NRS、QS、HADS评分均显著下降(P均<0.001);两组间各时点NRS、QS、HADS评分差异无统计学意义(P均>0.05);DNRS组术后各时点总有效率分别为80%(20/25例)、76%(19/25例)、76%(19/25例)、80%(20/25例)、64%(16/25例)、60%(15/25例),DCS组治术后各时点总有效率分别为65%(17/26例),81%(21/26例),77%(20/26例),73%(19/26例),62%(16/26例),58%(15/26例);两组间各时点总有效率差异无统计学意义(P=0.242、0.679、0.938、0.560、0.856、0.867,均>0.05);DNRS组患者的术后平均程控次数较DCS组低[(3.8±1.9)<(5.9±1.5),t=4.29,P<0.001]。结论短时程背根神经电刺激和脊髓背柱电刺激都能有效治疗带状疱疹相关性疼痛,但背根神经电刺激具有电刺激覆盖范围精准稳定、程控次数少的优点。Objective To compare the effects of short-term spinal cord stimulation(tSCS)at different catheterization sites on the treatment of patients with cervicothoracic zoster-associated pain(ZAP).Methods Fifty-one patients with ZAP in the Department of Painology,the Second Affiliated Hospital of Guangxi Medical University,aged 36-98 years old,both sexes,from October 2020 to July 2021 were collected and divided into dorsal nerve root stimulation group(DNRS group,25 cases)and spinal cord dorsal column stimulation group(DCS group,26 cases)according to the location of electrode implantation.The low frequency electric pulse mode with frequency less than 300 Hz and pulse width of 60-360μs was adopted.The voltage was adjusted according to the patient's demand.Numerical rating scales(NRS),quality of sleep(QS),the total effective rates were assessed at the different time points in pre-operation(before procedure,T0),post-operation 1 day(T1),3 day(T2),1 week(T3),1 month(T4),2 months(T5)and 3 months(T6).The degree of anxiety and depression were evaluated by Hospital Anxiety and Depression Scale(HADS)before the procedure(T0)and post-operation 1 month(T4),and the number of modulation during therapeutic period were recorded.Results Compared with T0,the NRS,QS and HADS scores were decreased significantly in the two groups at T1-T6(all P<0.001),but without significant differences between the two groups at each time point(all P>0.05).The effective rates were 80%(20/25 cases),76%(19/25 cases),76%(19/25 cases),80%(20/25 cases),64%(16/25 cases),60%(15/25 cases)in the DNRS group and 65%(17/26 cases),81%(21/26 cases),77%(20/26 cases),73%(19/26 cases),62%(16/26 cases),58%(15/26 cases)in the DCS group respectively,at each time point.There was no significant difference in the effective rates at each time point between the two groups(P=0.242,0.679,0.938,0.560,0.856,0.867,all>0.05).Compared with DCS group,the average number of modulation during therapeutic period was lower in the DNRS group[(3.8±1.9)vs.(5.9±1.5),t=4.29,P<0.001].Conclusion Both

关 键 词：带状疱疹相关性疼痛 短时程脊髓电刺 背根神经电刺激 脊髓背柱电刺激 程控次数 

分 类 号：R752.12[医药卫生—皮肤病学与性病学]