脉冲射频联合经皮神经电刺激治疗胸背部带状疱疹后遗神经痛效果研究

Study of the treatment of pulsed radiofrequency ablation combined with transcutaneous electrical nerve stimulation on postherpetic neuralgia

目的观察背根神经节脉冲射频(PRF)联合经皮神经电刺激(TENS)治疗胸背部带状疱疹后遗神经痛(PHN)的临床疗效,以及脑源性神经营养因子(BDNF)与疗效的相关性。方法将42例胸背部PHN患者随机分为PRF治疗组(P组)和PRF联合TENS治疗组(P+T组)。两组患者基础治疗均为常规给予治疗药物——加巴喷丁、曲马多和甲钴胺;P组在药物干预基础上行C型臂X线机引导下胸背部相应脊髓节段背根神经节PRF治疗;P+T组则同时给予C型臂X线机引导下胸背部相应节段背根神经节PRF及患处TENS治疗。于治疗前(T0)、PRF治疗后第2天(T1)、PRF治疗后1周(T2)、PRF治疗后2周(T3)、PRF治疗后1个(T4、PRF治疗后2个月(T5)观察两组患者疼痛视觉模拟评分(VAS)、睡眠质量评分(QS)、补救镇痛措施、不良反应,以及血清BDNF水平。结果两组患者治T0时一般情况、VAS、QS比较,差异均无统计学意义(P>0.05)。与T0时比较,两组患者T1~T5时VAS、QS均明显改善。,P+T组患者T2~T5时VAS、QS评分与P组比较,差异均有统计学意义(P<0.05)。与P组比较,P+T组患者需再次PRF治疗的数量明显减少,差异有统计学意义(P<0.05);且两组患者不良反应发生情况比较,差异无统计学意义(P>0.05)。与T0时比较,两组患者治疗后各时间点血清BDNF水平均不同程度增加,差异均有统计学意义(P<0.05);P+T组患者T4、T5时血清BDNF水平明显高于P组,差异均有统计学意义(P<0.05)。结论C型臂X线机引导下PRF联合TENS治疗胸背部PHN效果明确,安全性高,效果佳,机制可能与血清BDNF水平相关,值得临床应用。

Objective To observe the clinical effect of pulsed radiofrequency ablation combined with transcutaneous electrical nerve stimulation on postherpetic neuralgia in thoracodorsal and the correlation between brain-derived neurotrophic factor and therapeutic effect.Methods Forty-two patients with chest and back PHN were randomly divided into a pulse radiofrequency treatment group(P group)and a pulsed radiofrequency combined with transcutaneous electrical nerve stimulation(P+T group).The patients in both groups were routinely treated with gabapentin,tramadol,and mecobalamin;the group P was treated with percutaneous nerve electrical stimulation of the dorsal root ganglia in the thoracic and thoracic spine.In the P+T group,the C-arm machine was used to guide the percutaneous nerve electrical stimulation of the dorsal root ganglia and the TENS treatment.Before treatment(T0),the second day after PRF treatment(T1),1 week after PRF treatment(T2),2 weeks after PRF treatment(T3),1 month after PRF treatment(T4),2 months after PRF treatment(T5)Observed the pain score,sleep index,remedial analgesic measures,adverse reactions,and serum BDNF levels in the two groups.Results There was no significant difference in the visual analogue scale(VAS)and sleep quality score(QS)between the two groups(P>0.05).Compared with T0,the VAS score and QS score of T1-5 were significantly improved in P group and P+T group.At T2-5,the VAS score and QS score of the P+T group were significantly higher than those of the P group(P<0.05).Compared with the P group,the number of PRF treatments in the P+T group was significantly reduced(P<0.05);and there was no statistically significant increase in adverse reactions.By detecting serum BDNF levels,serum BDNF levels increased at different time points after treatment,and the difference was statistically significant(P<0.05);in T4,T5,P+T group The serum BDNF level was higher than that of the P group,and the difference was statistically significant(P<0.05).Conclusion Pulse radiofrequency combined with percutaneous electrical nerve stimulation for the treatment of thoracodorsal herpes zoster neuralgia has a clear effect,high safety,good effect,mechanism may be related to serum BDNF levels,the combination therapy is worthy of clinical application.