CT引导下脉冲射频调节术联合胸椎旁神经阻滞对带状疱疹后神经痛患者疼痛程度及生活质量的影响

Effects of CT-guided pulse radiofrequency ablation combined with thoracic paravertebral nerve block on pain degree and quality of life of patients with postherpetic neuralgia

目的 探讨CT引导下脉冲射频调节术联合胸椎旁神经阻滞对带状疱疹后神经痛患者疼痛程度及生活质量的影响。方法 选取2019年4月-2021年6月医院疼痛科收治的97例带状疱疹后神经痛患者作为研究对象,随机分为神经阻滞组(n=32)、射频调节组(n=31)和联合组(n=34);所有患者均接受常规药物治疗,在此基础上神经阻滞组接受胸椎旁神经阻滞治疗,射频调节组接受计算机断层扫描(Computed tomography, CT)引导下脉冲射频调节术治疗,联合组则先行CT引导下脉冲射频调节术,后行胸椎旁神经阻滞治疗;根据治疗前和治疗8周后患者数字评分量表(Numerical rating scale, NRS)评分降低程度来评价临床疗效;于治疗前、治疗1、4、8周后采用NRS量表评估疼痛情况,阿森斯失眠量表(Athens insomnia scale, AIS)评估睡眠质量,焦虑自评量表(Self-rating anxiety scale, SAS)和抑郁自评量表(Self-rating depression scale, SDS)评估焦虑和抑郁程度,36项健康调查简表(36-Item short-form, SF-36)评估生活质量;记录治疗后不良反应发生情况。结果 联合组(97.06%)和射频调节组(90.32%)治疗总有效率均显著大于神经阻滞组(71.88%)(P<0.05);与治疗前比较,3组治疗1、4、8周后NRS,AIS,SAS和SDS评分显著降低,SF-36评分显著增加(P<0.05);治疗1、4、8周后联合组NRS,AIS,SAS和SDS评分显著低于神经阻滞组和射频调节组,SF-36评分显著高于神经阻滞组和射频调节组(P<0.05);治疗1、4、8周后射频调节组NRS,AIS,SAS和SDS评分显著低于神经阻滞组,SF-36评分显著高于神经阻滞组(P<0.05);3组不良反应发生率比较无明显差异(P>0.05)。结论 CT引导下脉冲射频调节术联合胸椎旁神经阻滞治疗带状疱疹后神经痛疗效显著,有助于减轻患者疼痛程度,改善睡眠质量,减少焦虑和抑郁发生,提高生活质量,且安全性较高,临床可根据实际情况进行选择。

Objective To explore the effects of CT-guided pulse radiofrequency ablation combined with thoracic paravertebral nerve block on pain degree and quality of life in patients with postherpetic neuralgia. Methods From April 2019 to June 2021, 97 patients with postherpetic neuralgia admitted to the department of pain were selected as the research objects, and randomly divided into nerve block group(n=32), radiofrequency ablation group(n=31) and combined group(n=34). All patients were treated with conventional drugs. Based in this, the nerve block group was treated with thoracic paravertebral nerve block, the radiofrequency ablation group was treated with CT-guided pulse radiofrequency ablation, and the combined group was treated with CT-guided pulse radiofrequency ablation followed by the procedure of thoracic paravertebral nerve block. The clinical curative effect was evaluated with Numerical Rating Scale(NRS) before treatment, as well as 1 week, 4 weeks and 8 weeks after treatment. Athens Insomnia Scale(AIS), Self-rating Anxiety Scale(SAS) and Self-rating Depression Scale(SDS) were used to evaluate sleep quality, the degree of anxiety and depression, respectively. And SF-36 was used to evaluate the quality of life. Adverse effects of treatment were recorded. Results The total effective rates of combined therapy group(97.06%) and radiofrequency therapy group(90.32%) were significantly higher than that of nerve block group(71.88%)(P<0.05). Compared with the baselines, the scores of NRS, AIS, SAS and SDS in the three groups decreased significantly at 1 week, 4 weeks and 8 weeks after treatment, and the scores of SF-36 increased significantly(P<0.05). After treatment, the scores of NRS, AIS, SAS and SDS in the combined group were significantly lower than those both in the nerve block group and radiofrequency ablation group, and the scores of SF-36 were significantly higher than those in the nerve block group and radio frequency ablation group(P<0.05). After 1 week, 4 weeks and 8 weeks of treatment, the scores of NRS, AIS, SAS and SDS in radiofrequency ablation group were significantly lower than those in nerve block group, and the scores of SF-36 were significantly higher than those in nerve block group(P<0.05). There were no significant differences in the incidence of adverse effects among the three groups(P>0.05). Conclusion CT-guided pulse radiofrequency ablation combined with thoracic paravertebral nerve block is more effective in the treatment of postherpetic neuralgia, which is helpful to relieve the pain, improve sleep quality, reduce the occurrence of anxiety and depression, and improve the quality of life. It is safe and can be selected in the clinical practice according to the actual situation.