脉冲射频术治疗难治性胸段带状疱疹后神经痛20例疗效观察

CLINICAL OBSERVATION OF PULSE RADIOFREQUENCY IN THE TREATMENT OF REFRACTORY THORACIC POSTHEPETIC NEURALGIA: RESULTS FROM 20 CASES

目的:分析脉冲射频治疗难治性胸段带状疱疹后神经痛的临床效果及影响因素。方法:选择胸段带状疱疹后神经痛患者20例,既往口服常规推荐剂量的加巴喷丁或普瑞巴林联合非甾体类及阿片类镇痛药物时间超过1个月且效果不佳或不耐受,既往曾接受皮内阻滞和肋间神经阻滞效果不佳。C型臂引导下采用脉冲射频治疗受累胸神经根。采用简化的McGill疼痛问卷表综合评定治疗效果。结果:20例患者中19例有效,1例患者术后12个月复发。治疗前、治疗后1周,3个月,12个月的简式McGill疼痛问卷表(short-form of McGill pain questionnaire,SF-MPQ)分值分别为24.70±5.28,13.75±6.15,8.90±3.18,6.25±3.89,其中除术后3个月与术后12个月SF-MPQ差异无统计学意义外,前3组之间差异均有统计学意义(P<0.01)。所有患者均无严重不良反应。结论:脉冲射频术治疗难治性胸段带状疱疹后神经痛可迅速缓解疼痛,改善患者生活质量,疗效较确切且无严重不良反应。

Objective：To analyze the therapeutic effect of pulse radiofrequency for refractory thoracic postherpetic neuralgia and to evaluate its influence factors.Methods： Twenty patients with refractory thoracic postherpetic neuralgia were consecutively enrolled in our study.All the patients had received regular doses of gabapentin or pregabalin combined with non-steroid and opiates analgesic drug for over a month but with poor efficacy or non-tolerance.All the patients had received intradermal block and intercostal nerve block but with poor results.Pulse radiofrequency under the guidance of the C-arm X-ray equipment was used to treat the affected thoracic nerve root.The simplified McGill pain questionnaire was used to comprehensively evaluate the treatment effect.Results： Totally 19 cases of the patients were successfully treated and 1 case had recurrence 12 months after treatment.The short-form McGill pain questionnaire（SF-MPQ） values before treatment,and at 1 week,3 months and 12 months after treatment were 24.70±5.28,13.75±6.15,8.90±3.18 and 6.25±3.89,respectively.Statistical analysis suggested significant differences among the SF-MPQ values before treatment,and at 1 week and 3 months after treatment（P 0.01）.No significant difference was found between SFMPQ values at 3 months and 12 months.No patient had serious adverse reactions.Conclusion： The pulse radiofrequency treatment can alleviate the refractory thoracic postherpetic neuralgia rapidly,and improve the quality of life wifh no serious adverse reactions.