不同频率高频重复经颅磁刺激在带状疱疹后神经痛中的应用效果分析

Analysis of Application Effect of High-frequency Repetitive Transcranial Magnetic Stimulation at Different Frequencies in Postherpetic Neuralgia

目的 探究不同频率高频重复经颅磁刺激(HF-rTMS)在带状疱疹后神经痛(PHN)中的应用效果。方法 选取2019年5月至2021年5月南阳市中心医院收治的102例PHN患者作为研究对象,按照不同治疗方法将其分为假刺激组(33例)、5 Hz治疗组(32例)、10 Hz治疗组(37例),假刺激组患者予以模拟HF-rTMS治疗,5 Hz治疗组患者予以5 Hz HF-rTMS治疗,10 Hz治疗组患者予以10 Hz HF-rTMS治疗,对比观察3组患者疼痛程度、用药剂量变化情况、睡眠质量、舒适度、总体印象变化情况以及不良反应发生情况。结果 治疗4、8、12周后,5 Hz治疗组和10 Hz治疗组患者视觉模拟评分法(VAS)评分均明显低于假刺激组,且以10 Hz治疗组最低(F=19.401、51.201、55.031,P均<0.001);而3组患者药物调节情况(MR)评分均无明显差异(F=0.051、0.034、0.108,P=0.951、0.966、0.899)。治疗12周后,5 Hz治疗组和10 Hz治疗组患者匹兹堡睡眠质量指数(PSQI)评分明显低于假刺激组,且以10 Hz治疗组最低(F=18.825,P<0.001)。治疗8、12周后,5 Hz治疗组和10 Hz治疗组患者Bruggrmann舒适度量表(BCS)评分均明显高于假刺激组,且以10 Hz治疗组最高(F=30.920、79.523,P均<0.001);5 Hz治疗组和10 Hz治疗组患者总体印象变化量表(PGIC)评分均明显低于假刺激组,且以10 Hz治疗组最低(F=21.310、131.904,P均<0.001)。3组患者均未出现明显不良反应。结论 5 Hz与10 Hz HF-rTMS对PHN均具有一定的治疗效果,但10 Hz HF-rTMS对患者疼痛、睡眠质量、自觉症状的改善效果更佳。

Objective To analyze the application effect of high-frequency repetitive transcranial magnetic stimulation(HF-rTMS) at different frequencies in postherpetic neuralgia(PHN).Methods 102 patients with PHN admitted into Nanyang Central Hospital between May 2019 and May 2021 were enrolled as research subjects,and then divided into sham stimulation group(n=33),5 Hz treatment group(n=32) and 10 Hz treatment group(n=37).Patients in the sham stimulation group were given sham HF-rTMS,patients in the 5 Hz treatment group were given 5 Hz HF-rTMS,while patients in the 10 Hz treatment group were given 10 Hz HF-rTMS.The pain degree,medication dosage changes,sleep quality,comfort level,global impression changes and occurrence of adverse reactions of patients were compared among the three groups.Results Respectively after 4,8 and 12 weeks of treatment,the visual analogue scale(VAS) scores of patients both in the5 Hz treatment group and 10 Hz treatment group were obviously lower than that in the sham stimulation group,with the lowest in the 10 Hz treatment group(F=19.401,51.201 and 55.031,all P 0.001),but there were no statistically significant differences among the three groups in terms of medication reconciliation(MR) of patients(F=0.051,0.034 and0.108,P=0.951,0.966 and 0.899).After 12 weeks of treatment,the Pittsburgh sleep quality index(PSQI) scores of patients in the 5 Hz treatment group and 10 Hz treatment group were both lower than that in the sham stimulation group,also with the lowest in the 10 Hz treatment group(F=18.825,P 0.001).Respectively after 8 and 12 weeks of treatment,the Bruggrmann comfort scale(BCS) scores of patients both in the 5 Hz treatment group and 10 Hz treatment group were obviously higher than that in the sham stimulation group,with the highest in the 10 Hz treatment group(F=30.920 and79.523,both P 0.001),and the scores of patient global impression of change(PGIC) scale of patients both in the 5 Hz treatment group and 10 Hz treatment group were obviously lower than that in the sham stimulation group,with the lowest in the 10 Hz treatment group(F=21.310 and 131.904,both P 0.001).No obvious adverse reactions were observed among the three groups.Conclusion Both 5 Hz and 10 Hz HF-rTMS can realize definite clinical efficacy in the treatment of PHN,but 10 Hz HF-rTMS is much better in relieving patients' pain,and improving their sleep quality and subjective symptoms.