CT引导下臭氧联合脉冲射频治疗带状疱疹后神经痛的疗效及对血清炎性因子的影响

Effect of ozone combined with pulsed radiofrequency under CT guidance in the treatment of postherpetic neuralgia and its effect on serum inflammatory factors

目的观察在CT引导下背根神经节臭氧注射联合脉冲射频对老年患者带状疱疹后神经痛(PHN)的疗效、安全性及对血清肿瘤坏死因子(TNF)-α和白细胞介素(IL)-6水平的影响。方法将75例老年PHN患者随机分为A、B、C三组,各25例,在CT引导下A组给予臭氧注射治疗,B组给予脉冲射频治疗,C组给予臭氧注射联合脉冲射频治疗,三组在出现爆发痛时均口服吗啡即释片10mg。观察各组患者治疗前后的视觉模拟评分(VAS)、抑郁自评量表(SDS)评分和焦虑自评量表(SAS)评分及治疗后并发症,测定治疗前后血清炎性因子TNF-α、IL-6水平,并记录吗啡摄取量。结果治疗后3天、7天、30天、90天三组VAS评分均较治疗前降低,且在治疗后7天、30天、90天C组明显低于A、B两组(P<0.05);治疗后第1周、第4周、第8周及第12周内吗啡摄取量C组明显低于A、B两组(P<0.05);治疗后30天三组SDS、SAS评分均较治疗前降低,各组间差异无统计学意义(P>0.05);三组治疗后7天血清TNF-α、IL-6水平均较治疗前降低,且C组较A、B两组显著降低(P<0.05);三组患者治疗后均未出现严重并发症。结论 CT引导下背根神经节臭氧注射联合脉冲射频治疗老年患者PHN临床疗效确切,可减轻患者疼痛症状,减少止疼药物用量,并促进炎性因子平衡,且对于长期疼痛引起的焦虑及抑郁症状有明显的改善作用。

Objective To investigate the effect and its safety of ozone injection combined with pulsed radiofrequency in dorsal root ganglion under CT guidance in the treatment of elderly patients with postherpetic neuralgia(PHN), and effect on serum TNF-α and IL-6 levels. Methods Seventy-five patients with PHN were randomly divided into three groups: A, B and C(25 cases in each group). Under CT guidance, group A was given ozone injection therapy, group B was given pulsed radiofrequency therapy, and group C was given ozone injection combined with pulsed radiofrequency, patients received 10 mg morphine for bursting pain. Visual analogue scale(VAS) scores, depression self-rating scale(SDS) scores, anxiety self-rating scale(SAS) scores, post-treatment complications and the levels of serum TNF-α and IL-6 were measured before and after treatment, and the consumption of morphine was recorded. Results The VAS scores of all groups at 3 d, 7 d, 30 d and 90 d after treatments were lower than before, and group C was significantly lower than group A and B at 7 d, 30 d and 90 d after treatment(P<0.05). Compared with group A and B, the consumption of morphine in the first week, the 4 th week, the 8 th week and the 12 th week after treatment was significantly lower in group C(P<0.05). The SAS and SDS scores of all groups were lower than before and there were no differences among them(P>0.05). The levels of serum TNF-α and IL-6 decreased after treatment in all groups, and group C decreased significantly compared with group A and B(P<0.05). Serious complications were not found in all groups after treatments. Conclusion Ozone injection combined with pulsed radiofrequency in dorsal root ganglion under CT guidance in the treatment of elderly patients with PHN has definite clinical effect, which can alleviate the pain symptoms, reduce the amount of pain medication, promote the balance of inflammatory factors, and significantly improve the anxiety and depressive symptoms caused by long-term pain.