CT引导下局部注射多柔比星毁损背根神经节对胸背部带状疱疹后神经痛患者的效果

Efficacy of destruction of dorsal root ganglia with local doxorubicin injection under the guidance of CT for postherpetic neuralgia involving thoracic back region

目的评价CT引导下局部注射多柔比星毁损背根神经节对胸背部带状疱疹后神经痛患者的效果。方法胸背部带状疱疹后神经痛患者150例，采用随机数字表法，将其随机分为3组（n=50）：单纯口服药物治疗组（A组）、C型臂引导下局部注射多柔比星毁损背根神经节组（B组）和CT引导下局部注射多柔比星毁损背根神经节组（C组）。B组和C组在口服药物的基础上分别在C型臂和CT引导下毁损背根神经节，根据躯体神经的节段性分布选择疱疹病毒侵犯最重的3个节段脊神经。穿刺成功后，在每个节段注射试验剂量1％利多卡因1ml，15min后注射复方倍他米松4．7mg和多柔比星3．3mg。局部给药后根据疼痛程度继续口服羟考酮缓释片和加巴喷丁。记录患者因药物副作用退出情况。分别于局部给药前、局部给药后24h、1周、1、3、6个月进行VAS评分、睡眠干扰评分（SIS）和简化麦吉尔评分（SF-MPQ），并记录上述各时点口服药物剂量及局部给药后12h内气胸的发生情况。结果与A组比较，B组和C组因药物副作用退出率、VAS评分、SIS评分和SF-MPQ总分、羟考酮缓释片和加巴喷丁的剂量均降低（P〈0．05）；B组与C组间上述指标比较差异无统计学意义（P〉0．05）。B组气胸发生率为10％，C组无一例发生气胸，C组气胸发生率低于B组（P〈0．05）。结论CT引导下局部注射多柔比星毁损背根神经节可有效地减轻胸背部带状疱疹后神经痛患者疼痛，且安全性良好。

Objective To evaluate the efficacy of destruction of dorsal root ganglia with local doxorubicin injection guided by CT for postherpetic neuralgia involving thoracic back region. Methods One hundred and fifty patients suffering from postherpetic neuralgia in thoracic back region were randomly divided into 3 groups （ n = 50 each） ： group A oral medicine; B and C groups undergoing local injection under the guidance of C-ann and CT respectively ＋ oral medicine. Three spinal segments severely affected by herpes virus were chosen for paravertebral puncture. 1% lidocaine 1 ml was injected at each segment as test dose. Fifteen minutes later doxorubicin 3.3 mg and betamethasone compound 4.7 mg were injected at each segment if no side-effect occurred. All 3 groups were given oral medicine according to the intensity of pain after local injection. The number of patients who exited from the study because of the side effects of oral medicine was recorded. VAS, sleep interference score （SIS） and a short form of McGill pain questionnaire （SF-MPQ） were used to evaluate the efficacy of the treatment the day before （baseline）, 24 h, 1 week, 1, 3 and 6 months after local injection. The dosage of oxycodone extended-release tablets and gabapentin was recorded, and also the incidence of pneumothorax within 12 h after local injection. Resalts The exit rate, VAS, SIS and SF-MPQ scores, dosage of oxycodone extended-release tablet and gabapeutin were significantly lower in B and C groups than in group A, but there was no significant difference between the 2 groups. The incidence of pneumothorax was 10% in group B but no pneumothorax developed in group C. Conclusion Destruction of dorsal root ganglia with local doxorubicin injection guided by CT is more effective for the treatment of postherpetic neuralgia.