肋间神经射频热凝术治疗带状疱疹后神经痛20例疗效观察

Intercostal nerve radiofrequency coagulation treatment for postherpetic neuralgia: clinical observation of 20 cases

目的观察肋间神经射频热凝治疗带状疱疹后神经痛的疗效和安全性。方法 40例带状疱疹后神经痛患者(VAS≥4.0),随机分为A、B两组,每组20例:A组使用加巴喷丁、阿米替林、奥施康定等药物治疗;B组在上述药物治疗的基础上,联合肋间神经射频热凝进行治疗。观察患者行肋间神经射频术前,术后第1、7、30、90、180 d的疼痛视觉模拟评分(VAS)、奥施康定使用量、药物不良反应、治疗并发症等情况。结果 A组患者给药前,给药后第1、7、30、90、180 d VAS分别为:(8.2±1.6)、(6.1±1.7)、(4.2±1.4)、(3.6±1.1)、(3.3±1.3)和(2.7±1.2)分。奥施康定使用量分别为:(28.5±5.4)、(35.2±8.5)、(41.6±8.5)、(18.6±4.4)、(10.4±2.3)和(8.4±1.6)mg。B组患者术前,术后第1、7、30、90、180 d VAS分别为:(8.1±1.1)、(4.5±1.2)、(2.7±1.4)、(2.3±1.3)、(1.6±0.9)和(1.3±1.0)分。奥施康定使用量分别为:(28.7±5.8)、(17.3±5.4)、(12.3±3.8)、(5.1±1.7)、(5.6±1.1)和(4.0±1.1)mg,组间比较差异有统计学意义(P<0.05),B组药物不良反应轻微,无严重并发症。结论 X线透视下的肋间神经射频热凝术能迅速减轻疼痛,降低镇痛药使用量并减少其相关不良反应,是带状疱疹后神经痛的一种安全、有效的治疗方法。

Objective To evaluate the efficacy of fluoroscopy-guided intercostal nerve radiofrequency coagulation in treating postherpetic neuralgia. Methods A total of 40 patients with postherpetic neuralgia （VAS ≥ 4.0） were randomly and equally divided into two groups. Patients in group A （control group） were treated with gabapentin, amitriptyline and oxycodone, while patients in group B （study group） were treated with intercostal nerve radiofrequency coagulation together with the same medicines used in group A. VAS score and oxycodone dosage were determined before the treatment and one, 7, 30, 90 and 180 days after the treatment. The side effects and complications during the treatment were recorded. The results were analyzed and compared between the two groups. Results The VAS scores of patients in group A and group B before the treatment and one, 7, 30, 90 and 180 days after the treatment were （8.2 ± 1.6） vs （8.1 ± 1.1）, （6.1 ± 1.7） vs （4.5 ± 1.2）, （4.2 ± 1.4） vs （2.7 ± 1.4）, （3.6 ± 1.1） vs （2.3 ± 1.3）, （3.3 ± 1.3） vs （1.6 ± 0.9）, and （2.7 ± 1.2） vs （1.3 ± 1.0）, respectively （P〈0.05 in all）, while the oxycodone dosages in group A and group B were （28.5 ± 5.4） mg vs （28.7 ± 5.8） mg, （35.2 ± 8.5） mg vs （17.3 ± 5.4） mg, （1.6 ± 8.5） mg vs （12.3 ± 3.8） mg, （18.6 ± 4.4） mg vs （5.1 ± 1.7） mg, （10.4 ± 2.3） mg vs （5.6 ± 1.1） mg, and （8.4 ± 1.6）mg vs （4.0 ± 1.1）mg, respectively （P 〈 0.05 in all）. The drug side effects in group B were obviously very mild, and no serious complications occurred. Conclusion Fluoroscopy-guided intercostal nerve radiofrequency coagulation can rapidly relieve the pain in patients with postherpetic neuralgia, and reduce the oxycodone dosage and the occurrence of drug-related side effects as well. Therefore this technique is a safe and effective method for postherpetic neuralgia.