背根神经节脉冲射频术治疗神经病理性疼痛与瘙痒共病患者的疗效

Efficacy of pulse radiofrequency at dorsal root ganglion in the treatment of patients with comorbid neuropathic pain and itch

目的观察背根神经节脉冲射频术治疗神经病理性疼痛与瘙痒共病患者的疗效。方法回顾性收集延边大学附属医院疼痛科2019年3月1日至2021年3月1日收治的神经病理性疼痛与瘙痒共病患者46例,患者符合神经病理性疼痛的诊断标准且伴随瘙痒症状,瘙痒与疼痛部位相符。根据患者疼痛、瘙痒区域的神经分布特点确定患者受累节段,DSA引导下穿刺至椎间孔后下方,行背根神经节脉冲射频术治疗(2 Hz、45 V、42℃、300 s)。记录患者治疗前、治疗后1 d及治疗后1、4、12、24、48周时的疼痛数字等级评分(NRS)、匹兹堡睡眠质量指数(PSQI)、改良DUO瘙痒评分和皮肤病生活质量指数(DLQI);评估治疗后24、48周时疼痛及瘙痒的改善情况,记录并发症及不良反应。结果与治疗前相比,治疗后1 d及1、4、12、24、48周各时点NRS评分均明显降低(P均<0.05),治疗后1、4、12、24、48周各时点PSQI总分、改良DUO瘙痒评分、DLQI评分均明显降低(P均<0.05),DLQI总分在治疗后4周出现显著下降(P<0.05),其中症状感受、日常生活及休息娱乐评分下降低于其他项目(P均<0.05);治疗后24、48周时的疼痛改善优良率均优于瘙痒改善优良率[82.6%(38/46例)比54.3%(25/46例),χ^(2)=8.51,P=0.003;84.8%(39/46例)比60.9%(28/46例),χ^(2)=6.65,P=0.009],但均未见血肿、气胸、神经损伤、感染等严重并发症。结论背根神经节脉冲射频治疗疼痛与瘙痒共病疗效确切,可维持长达48周,并可有效缓解睡眠障碍,改善生存质量。

Objective To observe the efficacy of dorsal root ganglion pulse radiofrequency(RF)in patients with comorbid neuropathic pain and itch.Methods Forty-six patients with comorbid of neuropathic pain and itch,in Department of Pain Medicine,Yanbian University Affiliated Hospital,were collected from 1st March 2019 to 1st March 2021.The patients received DSA-guided dorsal root ganglion pulse RF according to affected segments.The numeric rating scale(NRS),Pittsburgh sleep quality index(PSQI),modified DUO pruritus score and dermatology life quality index(DLQI)were recorded and evaluated before the treatment,1 day after the treatment,and 4,12,24 and 48 weeks after the treatment.Complications and adverse effects were recorded.Results Compared with pre-treatment,NRS was decreased significantly at 1 day,and 1,4,12,24,48 weeks after the treatment(all P<0.05).There was a significant decrease respectively in PSQI,modified DUO pruritus score,and DLQI at 1,4,12,24 and 48 weeks after the treatment(all P<0.05).DLQI total score decreased significantly at 4 weeks after the treatment(P<0.05),especially the perception,daily living and rest and recreation score(all P<0.05).The improvement pain was better than that of pruritus at 24,48 weeks after the treatment[82.6%(38/46 cases)vs.54.3%(25/46 cases),χ^(2)=8.51,P=0.003;84.8%(39/46 cases)vs.60.9%(28/46 cases),χ^(2)=6.65,P=0.009],and no complications such as hematoma,pneumothorax,nerve injury and infection were found.Conclusion Pulse radiation frequency at dorsal root ganglion is effective in the treatment of patients with comorbid of neuropathic pain and itch,which can effectively relieve sleep disorders and improve quality of life and maintain for up to 48 weeks.