脉冲射频联合肋间神经阻滞治疗老年人胸背部带状疱疹后遗痛

Pulsed radiofrequency combined with intercostal nerve block for chest and back postherpetic neuralgia in elderly

目的观察脉冲射频(PRF)联合肋间神经阻滞治疗老年人胸背部带状疱疹后遗痛(PHN)的疗效。方法选择胸背部PHN患者60例,年龄60～95岁,病程3个月～3年,存在明显的中枢和外周疼痛敏感等症状,疼痛视觉模拟评分(VAS评分)≥4分。60例患者随机分入单纯肋间神经阻滞治疗组(神经阻滞组,30例)、PRF联合肋间神经阻滞治疗组(联合治疗组,30例)。神经阻滞组:行肋间神经阻滞,注射混合液(0.75%布比卡因10mL+确炎舒松A20mg+维生素B121.0mg,用0.9%氯化钠溶液配成20mL)。联合治疗组在行PRF后再行肋间神经阻滞。记录治疗前(T0)和首次治疗后24h(T1)、1周(T2)、1个月(T3)、3个月(T4)、6个月(T5)时的疼痛VAS评分。结果两组均未发现明显不良反应,T1至T5时间点的疼痛VAS评分均显著低于同组T0时间点(P值均<0.05),联合治疗组在T1至T3时间点的疼痛VAS评分均显著低于神经阻滞组同时间点(P值均<0.05)。结论 PRF联合肋间神经阻滞是治疗老年人胸背部PHN的一种简便、安全、有效的方法。

Objective To evaluate the effect of pulsed radiofrequency （PRF） combined with intercostal nerve block on chest and back postherpetic neuralgia （PHN） in elderly patients. Methods Sixty PHN patients, aged from 60 to 95 years, with central or peripheral hyperalgia （VAS score≥4） for 3 months to 3 years were enrolled in the study. They were randomly assigned to intercostal nerve block （group A, n = 30） or PRF combined with intercostal nerve block （group B, n = 30）. All the patients undertook intercostal nerve block with 20 mL mixed solution （0.75% bupivacaine 10 mL, triamcinolone acetonride 20 mg and vitamin B12 1.0 mg into normal saline）, and the patients in group B had PRF before the block. The VAS scores were recorded before treatment （T0）, and 24 h （T1）, 1 week （T2）, 1 month （T3）, 3 months （T4） and 6 months （T5） after the first treatment. Results No adverse reaction was found after treatment. VAS pain scores were significantly reduced in both groups at each time point after treatment as compared with those at To （all P〈0.05）. The VAS scores in group B were significantly lower than those in group A at T1, T2 and T3 （all P〈0. 05）. Conclusion PRF combined with intercostal nerve block is a safe and effective treatment for PHN of the chest and back in the elderly.