脉冲射频温度和时长对带状疱疹后神经痛疗效影响的临床研究

Effect of adjusting radiofrequency temperature and duration on clinical efficacy of postherpetic neuralgia during pulsed radiofrequency therapy

目的:本研究观察调整脉冲射频温度和时长治疗带状疱疹后神经痛的疗效及安全性。方法:采用前瞻性研究方法,选择2017年8月至2019年8月符合入选标准的胸部或腹部带状疱疹后神经痛病人160例,年龄50~89岁。采用随机数字表法将病人分为42℃+短时程组(n=40)、42℃+长时程组(n=40)、48℃+短时程组(n=40)、48℃+长时程组(n=40)。记录4组病人术前、术后、术后1月、3月时疼痛数字评分法(numerical rating scale,NRS)评分、术后3月普瑞巴林和曲马多使用量、比较4组病人治疗总有效率(疼痛缓解51%以上的病人占本组总人数的百分率)及显效率(疼痛缓解76%以上的病人占本组总人数的百分率)。结果:4组病人术后各时间点NRS评分均较术前明显降低,差异有统计学意义(P<0.05)。4组病人在术后1月,NRS评分各组间差异无统计学意义。术后3月,4组病人中48℃+短时程组NRS评分最低,差异有统计学意义(P<0.01)。与42℃+短时程组相比,42℃+长时程组术后NRS评分稍高,差异有统计学意义(P<0.01)。术后3月,4组病人中48℃+短时程组病人普瑞巴林使用量最小,与42℃+短时程组相比,差异有统计学意义(P<0.001)。4组病人中48℃+短时程组病人曲马多使用量最小,与42℃+短时程组相比,差异有统计学意义(P<0.05)。术后3月随访病人,42℃+短时程组病人疼痛治疗有效率100%、显效率22.5%,42℃+长时程组病人疼痛治疗有效率72.5%、显效率5%,48℃+短时程组病人疼痛治疗有效率95%、显效率42.5%,48℃+长时程组病人疼痛治疗有效率100%、显效率12.5%,提示48℃+短时程组病人中的显效率最高,明显疼痛缓解的病人多。结论:增加脉冲射频治疗温度至48℃行传统短时程治疗能更多减轻带状疱疹后神经痛病人的疼痛。

Objective:The purpose of this study was to investigate the effect and safety of adjusting the temperature and duration of pulsed radiofrequency(PRF)in the treatment of postherpetic neuralgia.Methods:One hundred and sixty cases of postherpetic neuralgia in chest or abdomen were selected,aged from 50 to 89.The patients were randomly divided into four groups:42℃+short term group(n=40),42℃+long term group(n=40),48℃+short term group(n=40),48℃+long term group(n=40).The numerical rating scale(NRS)score of 4 groups were recorded before,after,1 month and 3 months after operation.The dosage of pregabalin and tramadol were recorded 3 months after operation.The total effective rate(the percentage of patients with pain relief more than 51%accounted for the total number of the group)and the significant efficiency(the percentage of patients with pain relief above 76%in the total number of the group)were compared among the four groups 3 months after operation.Results:The NRS scores of the four groups were significantly lower than those before operation(P<0.05).There was no significant difference in NRS scores among the four groups at 1 month after operation.Three months after operation,the NRS score of 48℃+short term group was the lowest among the four groups(P<0.01).The dosage of pregabalin oral taken in 48℃+short term group was the lowest,compared with 42℃+short term group,the difference was statistically significant(P<0.001).The dosage of tramadol oral taken in 48℃+short term group was the lowest,compared with 42℃+short term group,the difference was statistically significant(P<0.05).After 3 months follow-up,the effective rate of pain treatment was 100%and the significant rate was 22.5%in the 42℃+short term group,72.5%and 5%in the 42℃+long term group,95%and 42.5%in the 48℃+short term group,100%and 12.5%in the 48℃+long term group.It is suggested that 48℃+short term treatment group has the highest effective rate,and more patients have obvious pain relief.Conclusion:PRF temperature regulation to 48℃with traditional short term treatment can reduce pain of postherpetic neuralgia more efficient.