短时程脊髓电刺激对药物治疗无效的急性带状疱疹神经病理性疼痛和运动麻痹的疗效观察

Effect of short-term spinal cord stimulation on acute herpetic neuralgia of drug treatment ineffective and motor paralysis

目的探讨短时程脊髓电刺激(st-SCS)治疗药物无效的急性带状疱疹神经病理性疼痛和肢体运动麻痹的临床疗效。方法选择2019年8月1日至2023年6月30日于南京医科大学附属南京医院疼痛科门诊收治的药物治疗无效的中重度急性带状疱疹神经痛(疱疹起始后1个月内)的34例患者,其中男性15例,女性19例;年龄51~73岁,平均年龄62.6岁;带状疱疹肢体麻痹累及单侧上肢21例,累及单侧下肢13例。接受st-SCS治疗,对治疗效果进行了回溯性分析,分别记录治疗前后各时间节点的疼痛程度的数字评定量表(NRS)评分、匹兹堡睡眠质量指数(PSQI)和疱疹累及的上肢腋神经、正中神经、尺神经及下肢股神经、腓肠神经在运动和感觉方面的神经传导速度(MNCV、SNCV),以及肌力评定量表(MRC)评级记录肌力变化详情。同时记录电刺激治疗周期内出现的不良反应。结果治疗前NRS为(8.2±0.8)分,治疗后14 d、1个月、3个月、6个月NRS评分显著下降[(4.3±1.1)分、(2.9±1.1)分、(2.3±0.9)分、(1.9±0.9)分],差异有显著统计学意义(t=16.52、22.45、27.62、29.60,P<0.001)。治疗前PSQI为14.6±1.6,治疗后3个月、6个月PSQI逐渐下降(5.6±1.1、3.9±0.8),差异有显著统计学意义(t=25.12、32.30,P<0.001)。说明睡眠质量也得到了显著的改善。治疗后3、6个月患者尺神经、正中神经及累及下肢股神经MNCV较治疗前有显著提高(P<0.001),且尺神经、腋神经和股神经SNCV较治疗前差异有统计学意义(P<0.05)。治疗后1、3、6个月,MRC评分逐步提高[(36.4±2.9)分、(38.6±3.7)分、(39.7±3.9)分],较治疗前差异有显著统计学意义(P<0.001)。结论st-SCS可以缓解急性带状疱疹神经痛并且促进受损神经的修复,改善肌力和提高睡眠质量,且不良反应少、安全性高。

Objective To investigate the clinical effect short-term spinal cord stimulation(st-SCS)on ineffective drug treatment for acute herpetic neuralgia and motor paralysis.Methods From August 1,2019 to June 30,2023,34 patients with moderate to severe acute herpes zoster neuralgia(within 1-month after herpes onset)ineffective in drug treatment were included,which included 15 males and 19 females,aged 51-73 years old with mean age of 62.6 years old.The herpes zoster limb paralysis involved unilateral upper limbs in 21 cases and unilateral lower limbs in 13 cases.The st-SCS were treated and therapeutic effect was retrospectively analyzed.The numerical rating scale(NRS)score of pain degree,Pittsburgh sleep quality index(PSQI),the motor nerve conduction velocity(MNCV)and sensory nerve conduction velocity(SNCV)of axillary nerve,median nerve,ulnar nerve of upper limb and femoral nerve,sural nerve of lower limb involved in motor and sensory aspects were recorded before and after treatment.The medical research council scale(MRC)was recorded the details of muscle strength changes,and the adverse effects of electrical stimulation during electrical stimulation treatment cycle were also recorded.Results The NRS score before treatment was(8.2±0.8)scores,and NRS scores at 14-day,1-month,3-month and6-month after treatment were significantly decreased[(4.3±1.1)scores,(2.9±1.1)scores,(2.3±0.9)scores,(1.9±0.9)scores],the difference was statistically significant(t=16.52,22.45,27.62,29.60,P<0.001).The PSQI was 14.6±1.6 before treatment,and PSQI decreased gradually at 3-month and 6-month after treatment(5.6±1.1,3.9±0.8),the difference was statistically significant(t=25.12,32.30,P<0.001),which showed that sleep quality was significantly improved.At 3-month and 6-month after treatment,the MNCV of ulnar nerve,median nerve and femoral nerve involved in lower extremity was significantly higher than that before treatment(P<0.001),and SNCV of ulnar nerve,axillary nerve and femoral nerve was significantly higher than that before treatment(P<0.05).At 1-month,3-month and 6-month after treatment,the MRC score were gradually increased[(36.4±2.9)scores,(38.6±3.7)scores,(39.7±3.9)scores],and there was statistically significant difference between before and after treatment(P<0.001).Conclusion It is demonstrated that st-SCS can relieve the pain of acute herpetic neuralgia,promote damaged nerves repair,improve muscle strength and improve sleep quality,with fewer adverse reactions and high safety.