超声引导下富血小板血浆椎旁神经根注射治疗顽固性躯干部带状疱疹后神经痛的疗效观察

Ultrasound-guided injection of platelet-rich plasma into paravertebral nerve root for the treatment of intractable somatic postherpetic neuralgia

目的:观察超声引导下富含血小板的血浆(PRP)椎旁神经根注射治疗顽固性躯干部带状疱疹后神经痛(SPHN)的临床疗效。方法:收集南通大学附属医院疼痛科门诊2021年3月至2021年8月病程>6个月的顽固性SPHN患者31例,予以口服普瑞巴林(首日晚口服75 mg,第2日开始75 mg/次,2次/d,后逐渐增大剂量,最大剂量150 mg/次,2次/d),嘱患者后期根据疼痛缓解程度逐渐减量,同时采用超声引导下PRP椎旁神经根注射治疗,记录患者治疗前以及治疗后1周,治疗后1、3及6个月以及治疗后1年时简式McGill疼痛问卷表(SF-MPQ)评分、阿森斯失眠量表(AIS)评估、汉密尔顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)评估。记录治疗前、治疗后各时点轻度疼痛(VAS 0~3分)患者的例数、口服药物剂量变化、不良反应及并发症发生情况。结果:与治疗前相比,治疗后1周、1、3及6个月、1年时患者VAS分别为(3.5±0.9,2.2±0.9,1.8±0.4,1.6±0.4,2.2±0.6)分,较治疗前的(6.7±1.0)分明显降低(P均<0.01);治疗后1周、1、3及6个月、1年时患者PRI分别为(9.3±3.7,5.8±2.5,3.9±2.3,3.5±2.0,3.8±1.8)分,较治疗前的(18.7±6.0)分明显降低(P均<0.01);治疗后1周、1、3及6个月、1年时患者PPI分别为(1.6±0.8,1.0±0.5,0.7±0.5,0.7±0.5,1.2±0.9)较治疗前的(3.2±0.8)明显降低(P均<0.01);治疗后1周、1、3及6个月、1年时患者的SF-MPQ总分分别为(14.4±4.2,9.1±3.2,6.4±3.0,5.8±2.6,7.2±2.6)较治疗前的(28.5±6.9)分明显降低(P均<0.01);治疗后1周、1、3及6个月、1年时患者的AIS分别为(5.0±2.6,4.4±2.3,4.1±2.3,4.1±2.4,4.1±2.4)分,较治疗前的(10.4±4.4)分明显降低(P均<0.01);治疗后1周、1、3及6个月、1年时患者的HAMD分别为(8.2±3.5,5.5±2.1,4.4±1.6,4.2±1.6,4.7±1.5)分,较治疗前(14.2±4.6)分,明显降低(P均<0.01);治疗后1周、1、3及6个月、1年时患者的HAMA分别为(7.3±3.4,4.9±2.0,4.3±1.5,4.0±1.6,4.5±2.0)分,较治疗前(13.0±4.4)分明显降低(P均<0.01);治疗后1周、1、3及6个月、1年时轻度疼痛(VAS 0~3分)患者例数分别为18例(58.1%)、28%(90.3%)、29例(93.6%),30例(96.8%)、30例(96.8%)较治疗前的0例明显增加(P均<0.01);与治疗前相比,治疗后1、3及6个月、1年时口服不同药物剂量的患者人数较治疗前均有所下降(P均<0.01)。治疗后未见明显不良反应及并发症。结论:超声引导下PRP椎旁神经根注射治疗可显著改善顽固性SPHN患者的疼痛及其生活质量,疗效确切,未见不良反应。

Objective To observe the clinical efficacy of ultrasound-guided injection of platelet-rich plasma(PRP)into paravertebral nerve roots for treatment of patients with intractable somatic postherpetic neuralgia(SPHN).Methods A total of 31 patients with intractable SPHN(more than 6 months),from March 2021 to August 2021,were collected from Painology Department of Affiliated Hospital of Nantong University.The patients received oral pregabalin 75 mg-150 mg/d and at the same time,received paravertebral nerve root PRP injection under ultrasound-guided.The numbers of patients with VAS 0-3 scores,short-form of McGill pain questionnaire(SF-MPQ),Athens insomnia scale(AIS),Hamilton depression scale(HAMD)and Hamilton anxiety scale(HAMA)were evaluated before the treatment and at 1 week,1 month,3 months,6 months and 1 year after the treatment.Adverse reactions and complications were recorded.Results The VAS scores of patients at 1 week,1 month,3 months,6 months,and 1 year after the treatment were(3.5±0.9,2.2±0.9,1.8±0.4,1.6±0.4,2.2±0.6)respectively,which were significantly lower than(6.7±1.0)scores before the treatment(all P<0.01).The PRI scores of patients at 1 week,1 month,3 months,6 months,and 1 year after the treatment were(9.3±3.7,5.8±2.5,3.9±2.3,3.5±2.0,3.8±1.8),which were significantly reduced compared to(18.7±6.0)scores before the treatment(all P<0.01).The PPI scores of patients at 1 week,1 month,3 months,6 months,and 1 year after the treatment were(1.6±0.8,1.0±0.5,0.7±0.5,0.7±0.5,1.2±0.9),which were significantly lower than those before the treatment(3.2±0.8)(all P<0.01).The total SF-MPQ scores of patients at 1 week,1 month,3 months,6 months,and 1 year after the treatment were(14.4±4.2,9.1±3.2,6.4±3.0,5.8±2.6,7.2±2.6)respectively,which were significantly lower than those before treatment(all P<0.01).At 1 week,1 month,3 months,6 months and 1 year after the treatment,the patients'AIS scores was(5.0±2.6,4.4±2.3,4.1±2.3,4.1±2.4,4.1±2.4,4.1±2.4)respectively,which were significantly reduced compared to that before the treatment(10.4±4.4),with statistical significance(all P<0.01).The HAMD scores of patients at 1 week,1 month,3 months,6 months,and 1 year after the treatment were(8.2±3.5,5.5±2.1,4.4±1.6,4.2±1.6,4.7±1.5),which were significantly reduced compared to(14.2±4.6)before the treatment(all P<0.01).The HAMA scores of patients at 1 week,1 month,3 months,6 months and 1 year after the treatment were(7.3±3.4,4.9±2.0,4.3±1.5,4.0±1.6,4.5±2.0),which were significantly lower than those before the treatment(13.0±4.4),with statistical significance(all P<0.01).The number of patients with VAS 0-3 increased gradually at each time point after the treatment(all P<0.01).Compared with before the treatment,the number of patients taking different doses of oral medicine decreased at each time point after the treatment(all P<0.01).No obvious adverse reactions and complications happened after the treatment.Conclusion Ultrasound-guided injection of PRP into paravertebral nerve roots can significantly improve the pain and quality in life of patients with intractable SPHN,and without adverse effects.