短时程脊髓电刺激对不同病程带状疱疹性神经痛的疗效分析

EFFECTIVENESS ANALYSIS OF TEMPORARY SPINAL CORD STIMULATION FOR ZOSTERRELATED NEURALGIA WITH DIFFERENT PHASE

目的:观察短时程脊髓电刺激(temporary spinal cCord sStimulation,tSCS)对不同病程带状疱疹性神经痛(zoster-related neuralgia,ZRN)的长期疗效。方法:本文采用回顾性分析纳入99例ZRN病人,包括42例急性疱疹性神经痛(acute herpetic neuralgia,AHN)病人,34例亚急性疱疹性神经痛(subacute herpetic neuralgia,SHN)病人以及23例疱疹后神经痛(postherpetic neuralgia,PHN)病人在保守治疗无效后接受1~2周t SCS治疗,对术前及术后1、3、6和12月等各时间段病人的疼痛程度、睡眠质量、镇痛药物使用情况进行汇总分析。结果:所有病人在t SCS治疗后VAS和PSQI均有明显下降(P<0.001)。然而AHN组和SHN组的两项评分比PHN组下降得更明显(P<0.001)。其中AHN组下降最明显。SHN和PHN组的VAS和PSQI在术后1个月有评分反弹现象。t SCS治疗后三组病人的镇痛药物使用人数均下降。AHN组的下降趋势最明显,随访3、6及12个月后AHN组中仍遗留疼痛的人数比例最少。本研究中未见严重不良反应。结论:tSCS是一种治疗早期顽固性ZRN非常安全有效的微创技术。与PHN相比,tSCS治疗AHN和SHN时效果更佳。

Objective: The long-term effectiveness of temporary spinal cord stimulation(tSCS) was observed on patients with different phase’s zoster-related neuralgia(ZRN). Methods: Nighty-nine patients who presented with acute herpetic neuralgia(AHN)(n = 42), subacute herpetic neuralgia(SHN)(n = 34) and postherpetic neuralgia(PHN)(n = 23), which had previously failed pharmacologic therapies and received the treatment of t SCS. Pain level, quality of life and analgesic consumptions were recorded and analyzed at baseline, post-tSCS, and 1, 3, 6 and 12 th month after tSCS treatment. Results: The average VAS and PSQI scores of all patients decreased signicantly during follow-up period compared with the baseline scores(P < 0.001). However, the mean scores of VAS and PSQI in the AHN and SHN groups dropped signicantly compared to the scores in the PHN group at the follow up intervals(P < 0.001). The greatest improvement in the AHN group. The scores in the SHN and PHN groups rebounded to a greater degree at 1-month follow up after tSCS treatment compared with the scores post tSCS(P < 0.001). The amounts of analgesic consumption in three groups decreased after tSCS treatment. The downward trend linear gradient of each medication in the AHN group was the largest among the three groups. The total effective therapeutic rate evaluated by the percentage of PHN after 3-month follow up was the highest in AHN group. No serious adverse events were observed. Conclusions: tSCS is an effective, safe, and less invasive analgesic method for patients with early refractory ZRN. Patients with AHN and SHN can get more benets from tSCS compared with PHN.