背根神经节脉冲射频或联合局部皮内阻滞治疗带状疱疹相关神经痛不同病程阶段的临床研究

Clinical study for pulsed radiofrequency of dorsal root ganglion or local intracutaneous block in the treatment of herpes zoster-related neuralgia at different stages

目的:比较背根神经节脉冲射频或联合皮内阻滞治疗带状疱疹神经痛不同时期的临床疗效。为背根神经节脉冲射频或联合皮内阻滞治疗带状疱疹神经痛的最佳时机提供理论依据。方法:收集2019年6月至2021年5月江汉大学附属湖北省第三人民医院疼痛科收治的胸腰背部带状疱疹神经痛患者123例分为3组:急性期(A组,n=42)、亚急性期(B组,n=38)、后神经痛期(PHN)(C组,n=43)。均在DSA引导下行背根神经节脉冲射频术(参数为温度42℃,频率2 Hz,电压40 V,治疗时长为10 min/每节段),记录3组术前1 d及术后1、3、15、30、90 d时患者的VAS评分和术后3 d时VAS≥4分的患者例数及VAS≥4分患者补行皮内阻滞治疗的例次。比较术后3、15、30及90 d时,背根神经节脉冲射频或联合皮内阻滞治疗带状疱疹神经痛不同时期的有效率。结果:A、B、C 3组患者术后各时点VAS评分均较术前下降(P均<0.05)。术后3 d,A组VAS评分为(2.7±0.4)明显低于B组(5.6±0.5)、C组(6.5±0.4)。术后第3日,A、B、C 3组患者VAS≥4分行皮内阻滞的例数/例次/总例数分别为(8/9/42、14/25/38、19/44/43)。A组术后3 d时VAS≥4分例数较B、C组少,联合皮内阻滞治疗例次明显少于B、C两组,差异有统计学意义(P均<0.05)。术后第3日,A、B、C 3组的治疗有效率分别为85.7%(36/42例)、60.5%(23/38例)、55.8%(24/43例),A组明显高于B组及C组,差异有统计学意义(P均<0.05)。结论:背根神经节脉冲射频或联合皮内阻滞治疗带状疱疹神经痛,对急性期、亚急性期、PHN期均有较好的临床疗效,急性期治疗效果优于PHN期,提示带状疱疹神经痛及早行脉冲射频或联合皮内阻滞治疗可以提高治疗效果,有效减少PHN的发生率。

Objective To compare the clinical efficacy of dorsal root ganglion pulsed radiofrequency(DRG RF)or combined local intradermal block(IB)for treatment of zoster-associated pain(ZAP)in different stages.Methods From June 2019 to May 2021,one hundred and twenty-three ZAP patients with thoracic lumbar back pain,in the Painology Department of Hubei Third People's Hospital of Jianghan University,were divided into three groups:group A(acute,n=42),group B(subacute,n=42),group C(PHN,n=43).All patients received dorsal root ganglion pulse radiofrequency therapy(parametric 42℃,2 Hz,40 V,10 min)in the guidance of digital subtraction angiography(DSA).VAS was evaluated on preoperative day,and 1,3,15,30 and 90 postoperative days.The numbers of VAS≥4 in postoperative days 3,and the times of local intradermal blockade treatment in the patients with VAS≥4 were record.Results Compared with the preoperative,the postoperative VAS in group A,B,C all decreased with statistical significance(P<0.05);the VAS was lower in the group A(2.7±0.4)than that in the group B(5.6±0.5),C(6.5±0.4),in 3 days after the treatment.The numbers,times,total patients treated with intradermal block were(8/9/42),(14/25/38),(19/44/43)in the group A,B,C respectively.Three days after the DRG RF,the numbers of VAS≥4 were lower in the group A than that in the group B,C,and the intradermal blockade times were significantly lower in the groups A than that in the group B,C(all P<0.05).The effective rate were significantly higher in the group A than that in the group B and the group C[85.7%(36/42 cases)vs.60.5%(23/38 cases)vs.55.8%(24/43 cases)]in 3 days after the DRG RF(all P<0.05).Conclusion DRG RF or combined IB has a significant treatment effect for all stages(acute/subacute/PHN)of ZAP,but the treatment effect was better in acute stage than in PHN stage;early treatment with DRG RF or combined IB for ZAP can improve the efficacy,decrease the incidence of PHN.