连续硬膜外注药联合神经根射频治疗老年带状疱疹后遗神经痛的研究

A study on the Efficacy of Radiofrequency Thermoagulation Lesion Applied to Nerve Roots after Continuous Epidural Analgesia as A Treatment on Postherpetic Neuralgia

目的：探讨连续硬膜外腔注药联合神经根热凝射频毁损治疗老年带状疱疹后遗神经痛的疗效和安全性方法：选择老年带状疱疹后遗神经痛患者40例，随机分为两组，A组（20例）在CT或C型臂引导定位下，进行硬膜外置管连续药物输注。持续药物输注2028天B组（20例）连续硬膜外置管药物输注后，在cT引导定位下，对支配相应病变区域的神经根行热凝射频毁损记录和比较治疗前、治疗后7天、1个月、6个月的视觉模拟评分（VAS）、生存质量评分（QOL）、疼痛缓解率、麻木评分和并发症发生率结果：两组患者治疗后7天、1个月、6个月的VAs评分和00L评分均明显低于治疗前（P〈0.05）：治疗后1个月、6个月B组的VAS显著低于A组（P〈0.05）：治疗后6月时B组的麻木评分显著低于A组（P〉0.05）治疗后1个月、6个月B组的疼痛缓解率显著低于A组tP〈O05），但治疗后并发症发生率B组显著高于A组（P〈0.05）结论：连续硬膜外腔注药后神经根热凝射频毁损方法治疗老年带状疱疹后遗神经痛，是一种有效的治疗方法，可以显著缓解患者疼痛；此方法虽然可能造成神经支配区域麻木．但安全可行。

Objective： To evaluate the safety and efficacy of nerve root radioffequency thermocoagulation tbllowed the continuous epidural infusion tbr the treatment ofpostherpetic neuralgia. Methods： 40 patients with postherpetic neuralgia were randomly assigned to group A （N=20） and group B （N=20）. In Group A, patients were performed epidural catheterization gtfided by CT or C-Ann. Continuous epidural infusions were given by a patient controlled pump for 20 to 28 days. Group B were given nerve root continuous radiofrequency thermocoagulation followed the continuous epidural infusion. Patients were asked to rate their pain on a （0-10 point） visual analog scale （VAS） at 7 days, 6 months and 1 year alter the treatment. Quality of life （QOL）, pain relief rate, numbness score, and the rate of complications were also recorded. Results： The VAS score and QOL score was decreased in both groups （P〈0.05） 24h, 1 month and 6 months after the treatment： compared with A group, the B group had lower VAS I month, 6 months and 2 years after the treatment （P〈0.05）. Besides, B group had lower numbness score than A group 1 months and 6 months after the treatment （P〉0.05）. A group had better therapeutic effect （P〈0.05）, but with more complications （P〈0.05）. Conclusions： 1. Nerve root radiofrequency thermocoagulation followed continuous epidural infusion is effective in the treatment of postherpetic neuralgia： the method can cause the numbness of the nerve innervated region; however, it is a sate therapeutic method.