不同温度腰交感神经节射频热凝术在痛性糖尿病周围神经病中的应用

Application of lumbar sympathetic nerve radiofrequency thermocoagulation at different temperatures in painful diabetic peripheral neuropathy

目的研究不同温度腰交感神经节射频热凝术治疗痛性糖尿病周围神经病(DPN)的有效性和安全性。方法纳入2019年5月至2021年9月该院收治的40例下肢痛性DPN患者为研究对象,采用随机数字表法将患者分为低温组与高温组,每组20例。所有患者均接受CT引导下单侧腰交感神经射频热凝术,低温组射频温度为65℃,高温组为80℃。记录两组数字疼痛分级法(NRS)评分、匹兹堡睡眠质量指数(PSQI)评分、踝臂指数(ABI)及并发症发生情况,评估患者对治疗的满意度。结果治疗后低温组与高温组的ABI较治疗前明显升高(P<0.05)。与治疗前比较,低温组与高温组治疗后第2天及1、3、6个月的NRS评分显著降低(P<0.05)。治疗后1、3、6个月的PSQI评分明显降低(P<0.05)。治疗6个月后,低温组与高温组患者满意度比较,差异无统计学意义(P>0.05)。低温组和高温组各出现1例生殖股神经损伤,其中低温组患者症状恢复时间为术后1个月,高温组为术后3个月,两组均无出血、感染等其他并发症。结论腰交感神经节持续射频热凝治疗痛性DPN可以显著提高患者生活质量。持续射频热凝治疗中应用不同维持温度,缓解疼痛的效果无显著性差异,且低温相对更安全。

Objective To investigate the efficacy and safety of radiofrequency thermocoagulation of lumbar sympathetic nerve at different temperatures in the treatment of painful diabetic peripheral neuropathy(DPN).Methods Forty painful DPN patients of lower extremities admitted to the hospital from May 2019 to Septem-ber 2021 were included and divided into hypothermia group and hyperthermia group by random number table method,20 cases in each group.All patients underwent CT-guided lumbar sympathetic radiofrequency thermo-coagulation,and the radiofrequency temperature was 65℃in the hypothermia group and 80℃in the hyper-thermia group.Pain score(NRS score),Pittsburgh sleep quality index(PSQI)score,ankle-brachial index(ABI)and complications in both groups were recorded,and patients'satisfaction with the treatment was as-sessed.Results After treatment,the ABI of the two groups was significantly higher than that before treat-ment(P<0.05).Compared with before treatment,the NRS scores at the second day and 1,3,6 months after treatment in both groups decreased obviously(P<0.05),the PSQI scores at 1,3,6 months after treatment declined significantly(P<0.05).After 6 months of treatment,the difference of patients satisfaction between the two groups had no statistical significance(P>0.05).Meanwhile,1 case of genitofemoral nerve injury oc-curred in both groups separately,and the patient's symptom recovery time was 1 month after treatment in the hypothermia group and 3 months after treatment in the hyperthermia group;there were no complications of bleeding and infection in both groups.Conclusion Continuous radiofrequency thermocoagulation of lumbar sympathetic nerves in the treatment of painful DPN can significantly improve patients'life quality.The appli-cation of different maintenance temperatures in continuous radiofrequency thermocoagulation has no signifi-cant difference in pain relief,and hypothermia is relatively safer.