短时程脊髓电刺激治疗带状疱疹后神经痛效果不佳的影响因素分析

Analysis of influencing factors for poor effect of short-term electrical spinal cord stimulation in treatment of postherpetic neuralgia

目的:分析短时程脊髓电刺激治疗带状疱疹后神经痛(PHN)效果不佳的影响因素。方法:回顾性收集2017年7月至2022年7月采用短时程脊髓电刺激治疗PHN患者的病历资料,年龄40~85岁,性别不限,ASA分级Ⅰ或Ⅱ级。术后3个月时采用改良MacNab疗效分级评估治疗效果,并根据治疗效果将患者分为疗效佳组(治疗效果为优和良)和疗效不佳组(治疗效果为可和差)。收集患者一般资料、病程、病变部位、合并疾病、病变脊柱节段黄韧带骨化情况、疱疹期疼痛程度、疱疹期规范抗病毒治疗(抗病毒7 d以上)情况和疱疹期营养神经药物使用情况(使用7 d以上)。采用多因素logistic回归分析筛选短时程脊髓电刺激治疗PHN效果不佳的影响因素。结果:本研究最终纳入168例患者,其中疗效不佳69例,疗效不佳率为41.1%。多因素logistic回归分析结果显示,患者年龄(OR=2.230,P=0.015)、病程(OR=2.191,P=0.027)、合并糖尿病(OR=8.859,P=0.010)、同节段黄韧带骨化(OR=6.602,P=0.019)、疱疹期疼痛程度(OR=5.788,P=0.038)及疱疹期未规范抗病毒治疗(OR=6.765,P=0.021),是脊髓电刺激治疗PHN效果不佳的影响因素。结论:患者年龄、病程、合并糖尿病、同节段黄韧带骨化、疱疹期疼痛程度及疱疹期未规范抗病毒治疗,是短时程脊髓电刺激治疗PHN效果不佳的影响因素。

Objective To analyze the factors influencing the poor effect of short-term electrical spinal cord stimulation in the treatment of postherpetic neuralgia(PHN).MethodsThe medical records of PHN patients of either sex,aged 40-85 yr,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,who received short-term electrical spinal cord stimulation from July 2017 to July 2022,were retrospectively collected.The therapeutic effect was evaluated using the modified MacNab criteria at 3 months after operation,and the patients were divided into good efficacy group(excellent and good efficacy)and poor efficacy group(fair and poor efficacy).General information,disease course,lesion site,complicated diseases,ossification of the yellow ligament in the diseased spinal segment,severity of pain in the herpetic stage,standard antiviral therapy in the herpetic stage(for more than 7 days)and use of neurotrophic drugs in the herpetic stage(for more than 7 days)were collected.Multivariate logistic regression analysis was used to screen the influencing factors for the poor effect of electrical spinal cord stimulation in the treatment of PHN.ResultsA total of 168 patients were eventually enrolled,among which 69 had poor curative effect,and the rate of poor curative effect was 41.1%.The results of multivariate logistic regression analysis showed that the patient′s age(OR=2.230,P=0.015),course of disease(OR=2.191,P=0.027),complication with diabetes mellitus(OR=8.859,P=0.010),ossification of ligamentum flavum at the same segment(OR=6.602,P=0.019),severity of pain in the herpetic stage(OR=5.788,P=0.038)and non-standard antiviral therapy in the herpetic stage(OR=6.765,P=0.021)were the influencing factors for the poor effect of electrical spinal cord stimulation in the treatment of PHN.ConclusionsAge,course of disease,complication with diabetes mellitus,ossification of ligamentum flandum at the same segment,severity of pain in the herpetic stage and non-standard antiviral therapy in the herpetic stage are the factors influencing the poor effect of short-term electrical spinal cord stimulation in the treatment of PHN.