颈段硬膜外腔短时程脊髓电刺激联合周围神经电刺激治疗枕神经带状疱疹后神经痛患者的可行性  

Feasibility of short-term cervical epidural spinal cord stimulation combined with peripheral nerve stimulation in the treatment of patients with postherpetic neuralgia in occipital nerve

作　　者：陈苏 王艳萍[1] 郭海明[2] 孔存龙[1] 李新新[1] 樊肖冲[1] 卜慧莲[1] Chen Su;Wang Yanping;Guo Haiming;Kong Cunlong;Li Xinxin;Fan Xiaochong;Bu Huilian(Department of Painology,Anesthesiology and Perioperative Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou City,Henan Province 450052,China;Department of Anesthesiology,Anesthesiology and Perioperative Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou City,Henan Province 450052,China)

机构地区：[1]郑州大学第一附属医院麻醉与围术期医学部疼痛科,郑州市450052 [2]郑州大学第一附属医院麻醉与围术期医学部麻醉科,郑州市450052

出　　处：《中华疼痛学杂志》2024年第1期84-90,共7页Chinese Journal Of Painology

摘　　要：目的观察颈段硬膜外腔短时程脊髓电刺激(SCS)联合周围神经电刺激(PNS)治疗枕神经带状疱疹后神经痛(PHN)的疗效及安全性。方法回顾性收集2018年1月至2021年12月在郑州大学第一附属医院麻醉与围术期医学部疼痛科住院的枕神经PHN患者57例,年龄、性别不限,病程>1个月,视觉模拟评分(VAS)>5分,并根据不同电刺激植入方式将患者分为3组:SCS-PNS组、SCS组和PNS组。SCS-PNS组患者同时接受颈段(C_(1)~C_(2))硬膜外腔脊髓电刺激和周围神经(枕神经)电刺激,SCS组患者接受颈段(C_(1)~C_(2))硬膜外腔脊髓电刺激,PNS组患者接受周围神经(枕神经)电刺激。记录治疗前患者的一般资料、视觉模拟评分(VAS)、匹兹堡睡眠质量指数(PSQI),并在术后1、3、5、7、14、21 d时记录患者VAS评分及VAS≤3分患者的例数。记录患者术后21 d的PSQI评分,记录3组患者的电极拔出时间及不良事件发生情况。结果最终共30例患者完成治疗及随访,其中,SCS-PNS组11例,SCS组11例,PNS组8例。与治疗前相比,3组患者治疗后VAS、PSQI评分均降低(P均<0.05)。与PNS组相比,SCS-PNS组VAS评分从治疗后3 d开始就出现明显下降(P<0.05)。治疗后3 d时,SCS-PNS组和SCS组即出现VAS≤3分的病例(P均<0.05)。与SCS组和PNS组相比,SCS-PNS组在治疗后21 d时的VAS评分及PSQI评分更低(P均<0.05)。与SCS组相比,SCS-PNS组和PNS组电极拔出时间较晚,治疗时间更稳定(F=4.04,P=0.029)。3组患者均未见严重不良事件。结论短时程颈段硬膜外腔SCS联合PNS治疗枕神经PHN的疗效显著,优于单纯SCS或PNS治疗,且不增加不良事件发生。Objective To observe the efficacy and safety of short-term cervical epidural spinal cord stimulation(SCS)combined with peripheral nerve stimulation(PNS)to treatment of postherpetic neuralgia(PHN)in occipital nerve.Methods A total of 57 patients with PHN in occipital nerve,no limitation of age and gender,the duration of the disease>1 month,visual analogue scale(VAS)>5,were retrospectively collected from the Department of Painology,Anesthesiology and Perioperative Medicine,The First Affiliated Hospital of Zhengzhou University from January 2018 to December 2021.The patients were divided into three groups according to different stimulation methods:SCS-PNS group,SCS group and PNS group.Patients received cervical(C_(1)-C_(2))epidural spinal cord electrical stimulation and peripheral nerve(occipital nerve)electrical stimulation implantation therapy in the SCS-PNS group;cervical(C_(1)-C_(2))epidural spinal cord electrical stimulation implantation therapy in the SCS group;and peripheral nerve(occipital nerve)electrical stimulation in the PNS group.The patients'general condition,VAS and Pittsburgh sleep quality index(PSQI)were recorded before the treatment.VAS and the number of patients with VAS≤3 were recorded at 1,3,5,7,14,21 days after the treatment,and PSQI were recorded at 21 days after the treatment.The time of electrode removal and the occurrence of adverse events were recorded in 3 groups.Results Thirty patients finished the treatment and follow up,including 11 patients in the SCS-PNS group,11 patients in the SCS group,and 8 patients in the PNS group.Compared with the pretreatment,VAS and PSQI were decreased at each time point after the treatment in the three groups(all P<0.05).Compared with the PNS group,VAS decreased significantly from the third day after the treatment in the SCS-PNS group and SCS group(all P<0.05).Compared with the SCS group and PNS group,VAS and PSQI were lower at 21 days after the treatment in the SCS-PNS group(all P<0.05).Compared with the SCS group,the electrode removal time point was late

关 键 词：神经痛 带状疱疹后 脊髓电刺激 周围神经电刺激 枕神经 

分 类 号：R752.12[医药卫生—皮肤病学与性病学]