短时程脊髓电刺激对带状疱疹性神经痛的疗效评价

Effectiveness of temporary spinal cord stimulation in herpetic neuralgia

目的探讨短时程脊髓电刺激(SCS)治疗带状疱疹性神经痛的临床疗效。方法回顾性收集自2017年1月至2019年1月广州医科大学附属第二医院疼痛科收治的病程在3个月内的急性、亚急性期带状疱疹性神经痛患者资料,所有患者均行短时程SCS治疗。记录患者治疗前、治疗后第7天、第30天及第90天时药量变化情况、疼痛与睡眠变化情况,以及后遗症和并发症。结果(1)术后第30天,超过50%的患者停止用药。术后第90天,75.2%(82例)的患者停药;24.8%(27例)的患者仍有疼痛发作,需继续服用药物,但药量较前减少。(2)患者术后视觉模拟评分法(VAS)评分、睡眠质量评分均随时间延长逐渐降低,术后第7天开始与术前评分差异即有统计学意义(P<0.05)。(3)术后第90天,24.8%(27例)的患者发展成为带状疱疹后遗神经痛,VAS评分4~6分,未影响日常生活及睡眠。所有患者均未出现严重并发症。结论短时程SCS治疗可以明显缓解患者疼痛,有效降低带状疱疹性神经痛向带状疱疹后遗神经痛转化的几率。

Objective To evaluate the clinical outcomes of temporary spinal cord stimulation(SCS)in treatment of herpetic neuralgia.Methods Patients with diagnosed herpetic neuralgia at acute or subacute periods received SCS in our hospital from January 2017 to January 2019.Changes of drug dosage,changes of pain and sleep,sequelae,and complications were recorded before and 7,30 and 90 d after treatment.Results(1)Thirty d after surgery,more than 50%patients stopped using the drugs;90 d after surgery,75.2%patients(n=82)stopped using the drugs;24.8%of the patients(n=27)still had pain episodes and needed medication,but the dosage was less than before.(2)Visual analogue scale(VAS)scores and simple sleep quality scale scores decreased gradually with the extension of time,and these scores 7,30 and 90 d after treatment were statistically different as compared with those before treatment(P<0.05).(3)On the 90th d of follow-up,24.8%patients(n=27)developed post-herpetic neuralgia,with VAS scores ranging from 4 to 6,and without affecting their daily life and sleep;none of the patients had serious complications.Conclusion Temporary SCS is an effective way to relieve pain,and it can also reduce the incidence of post-herpetic neuralgia.