双靶点经颅直流电刺激治疗头面部带状疱疹后神经痛的临床研究  

Dual-target transcranial direct current stimulation for treating craniofacial postherpetic neuralgia

作　　者：高鑫 黄运健 倪兵[1] 卢光[1] 朱宏伟[1] 杜涛[1] GAO Xin;HUANG Yun-jian;NI Bing;LU Guang;ZHU Hong-wei;DU Tao(Department of Functional Neurosurgery,Xuanwu Hospital Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院功能神经外科,北京100053

出　　处：《中国疼痛医学杂志》2024年第12期928-933,共6页Chinese Journal of Pain Medicine

基　　金：国家重点研发计划(2022YFC3602203);国家自然科学基金联合基金项目(U20A20391)。

摘　　要：目的:探究双靶点经颅直流电刺激(transcranial direct current stimulation,tDCS)治疗头面部带状疱疹后神经痛(craniofacial postherpetic neuralgia,C-PHN)的疗效。方法:选取2024年2月至2024年5月在首都医科大学宣武医院就诊的C-PHN病人40例,采用计算机随机数字生成方式均分为治疗组和对照组,治疗组采用初级运动皮质(primary motor cortex,M1)和前额叶背外侧部(dorsolateral prefrontal cortex,DLPFC)双靶点t DCS交替刺激,对照组采用假刺激,两组均刺激10天。分别采用视觉模拟评分法(visual analogue scale,VAS)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)和匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评估刺激前后的变化值,评价两组病人疼痛、抑郁和睡眠的改善情况,分析影响疼痛变化的相关因素。结果:从第6次刺激后,治疗组VAS评分改善情况开始显著优于对照组(P<0.05)。在第10次刺激后即刻和刺激后1个月,治疗组VAS评分、HAMD评分和PSQI评分的改善情况均显著优于对照组(P<0.05)。病程≤2个月是影响病人疗效的保护因素(OR=30.881,P=0.047)。结论:M1和DLPFC双靶点tDCS是治疗C-PHN的有效方法,病程≤2个月者治疗效果更佳。Objective:To investigate the efficacy of dual-target transcranial direct current stimulation(tDCS)for treating craniofacial postherpetic neuralgia(C-PHN).Methods:Forty C-PHN patients from February 2024 to May 2024 treated in Xuanwu Hospital Capital Medical University were selected and randomly divided into the treated group and the control group in a 1:1 ratio.The treated group received alternating stimulation of the primary motor cortex(M1)and dorsolateral prefrontal cortex(DLPFC)using dual-target tDCS,while the control group received sham stimulation.Both groups underwent 10 days of stimulation.Changed visual analogue scale(VAS),Hamilton depression scale(HAMD),and Pittsburgh sleep quality index(PSQI)scores before and after stimulation were used to evaluate the improvement of pain,depression,and sleep.Factors influencing th pain changes were analyzed.Results:Starting from the 6 stimulation,the improvement of VAS scores in the th treated group became significantly better than in the control group(P<0.05).After the 10 stimulation,both immediately and one month later,the treated group showed significantly greater improvements in VAS,HAMD,and PSQI scores compared with the control group(P<0.05).A pain duration of≤2 months was identified as a protective factor for treatment efficacy(OR=30.881,P=0.047).Conclusion:Dual-target tDCS of M1 and DLPFC is an effective treatment for C-PHN,with better outcomes for patients with a pain duration of≤2 months.

关 键 词：头面部带状疱疹后神经痛 经颅直流电刺激 运动皮质 前额叶背外侧部 

分 类 号：R752.12[医药卫生—皮肤病学与性病学]