4种方式治疗三叉神经第一支带状疱疹性神经痛的疗效比较

Observation on the therapeutic effect of four different methods in the treatment of herpetic neuralgia at the first branch of the trigeminal nerve

目的对比研究临床常用的4种方式治疗三叉神经第一支带状疱疹性神经痛的疗效。方法分析遵义医科大学附属医院疼痛科2020年7月至2023年7月诊断为三叉神经第一支带状疱疹性神经痛的病人52例,根据治疗方案分为4组,SNB组(眶上神经阻滞)10例,S-PRF组(眶上神经脉冲射频)12例,TG-PRF组(三叉神经节脉冲射频)13例,PNS组(眶上神经电刺激)17例。对比4组术前、术后NRS评分及疼痛爆发次数、普瑞巴林和曲马多用量、PSQI评分。结果疼痛情况:与术前对比,4组患者术后1、4、12周的NRS评分及疼痛爆发次数较术前均降低(P<0.05)。组间对比,术后4周,SNB组NRS评分高于其他3组,PNS组评分最低(P<0.05);术后12周,PNS组NRS评分及疼痛爆发次数低于其他3组(P<0.05)。睡眠情况:与术前对比,4组患者术后1、4、12周的PSQI评分较术前均降低(P<0.05)。组间对比,术后12周,PNS组PSQI评分低于其他3组(P<0.05)。用药情况:与术前对比,只有PNS组术后12周的普瑞巴林用量较术前降低。组间对比,术后12周,PNS组普瑞巴林用量明显低于其他3组(P<0.05)。与术前对比,4组患者术后1、4、12周的曲马多用量较术前均降低(P<0.05)。组间对比,术后12周,PNS组曲马多用量明显低于其他3组。PNS组带状疱疹后遗神经痛(PHN)发生率低于其他3组(P<0.05)。结论4种治疗方式均能缓解疼痛、改善睡眠、减少止痛药用量及降低PHN发生率,但从远期效果上看,眶上神经电刺激的效果优于其它3种治疗方式。

Objective To compare and study the therapeutic effects of four commonly used methods in clinical treatment of herpes zoster neuralgia of the first branch of the trigeminal nerve.Methods A total of 52 patients diagnosed with herpes zoster neuralgia in the first branch of the trigeminal nerve at the Pain Department of the Affiliated Hospital Zunyi Medical University from July 2020 to July 2023 were analyzed.They were divided into four groups according to the treatment plan:10 cases in the SNB group(supraorbital nerve block),12 cases in the S-PRF group(supraorbital nerve pulsed radiofrequency treatment),13 cases in the TG-PRF group(trigeminal ganglion pulse radiofrequency),and 17 cases in the PNS group(supraorbital nerve electrical stimulation treatment).The preoperative and postoperative NRS scores,number of pain outbreaks,dosage of pregabalin and tramadol,and PSQI scores among four groups were compared.Results Pain situation:Compared with preoperative baselines,the NRS score and number of pain outbreaks of the four groups of patients decreased at 1,4,and 12 weeks postoperatively(P<0.05).Four weeks after surgery,the NRS score of the SNB group was higher than the other three groups,while the NRS score of the PNS group was lower than the other three groups(P<0.05);At 12 weeks post surgery,the NRS score and number of pain outbreaks in the PNS group were lower than those in the other three groups(P<0.05).Sleep status:Compared with preoperative baseline,the PSQI scores of the four groups of patients decreased at 1,4,and 12 weeks postoperatively(P<0.05).At 12 weeks post surgery,the PSQI score of the PNS group was lower than that of the other three groups(P<0.05).Medication situation:Compared with preoperative,only the PNS group had a decrease in the dosage of pregabalin at 12 weeks post surgery.At 12 weeks after surgery,the dosage of pregabalin in the PNS group was significantly lower than that in the other three groups(P<0.05).Compared with preoperative baselines,the dosage of tramadol in all four groups of patients decreased at 1,4,and 12 weeks postoperatively(P<0.05).Inter group comparison showed that at 12 weeks post surgery,the dosage of tramadol in the PNS group was significantly lower than that in the other three groups.The incidence of PHN in the PNS group was lower than that in the other three groups(P<0.05).Conclusion All four treatment methods can alleviate pain,improve sleep,reduce analgesic dosage,and lower the incidence of PHN.However,in terms of long-term effects,the effect of supraorbital nerve electrical stimulation is superior to the other three treatment methods.