发散式冲击波治疗不同类型带状疱疹神经痛的临床研究

The clinical study of diffuse shock wave in the treatment of different types of postherpetic neuralgia

摘要:

目的：观察发散式冲击波治疗不同类型带状疱疹性神经痛的临床疗效。方法 选取本院疼痛门诊2017年1月至2018年9月期间收治的确诊为带状疱疹性神经痛患者120例。根据疼痛类型分为4组（n = 30），激惹型（A组）：病人因无髓鞘纤维的异常敏化，表现为痛觉敏化；麻痹型（B组）：病人会出现痛温觉丧失明显，轻触痛不明显；混合型（C组）：在临床上兼有激惹型和麻痹型的表现；无激惹型（D组）：病人患区疼痛明显，临床检查无明显的浅感觉变化或异常痛觉变化。所有病人均采用基础疗法：钙通道调节、神经营养、椎旁神经阻滞治疗；在基础治疗法上每周进行1次发散式冲击波。记录治疗时间。观察治疗前和治疗后1、7、14天采用视觉模拟评分（VAS评分）评估疼痛程度，汉密尔顿焦虑量表（HAMA评分）、观察不良反应。结果：与治疗前比较，四组治疗后7、14天VAS评分、HAMA 总分、躯体性焦虑因子总分和精神性焦虑因子总分均降低（Ｐ＜0.0５）;激惹型和混合型相比较，麻痹型和无激惹型相比较治疗后7、14天VAS评分、HAMA 总分、躯体性焦虑因子总分和精神性焦虑因子总分无明显统计学意义（Ｐ＞0.0５）；激惹型与麻痹型、无激惹型相比较治疗后7、14天VAS评分、HAMA 总分、躯体性焦虑因子总分和精神性焦虑因子总分降低（Ｐ＜0.0５）；混合型与麻痹型、无激惹型相比较治疗后7、14天VAS评分、HAMA 总分、躯体性焦虑因子总分和精神性焦虑因子总分降低（Ｐ＜0.0５）。结论：发散式冲击波可作为一种辅助性治疗，治疗带状疱疹性神经痛患者，尤其对激惹型和混合型带状疱疹性神经痛远期的治疗效果较好，并提高常规治疗的疗效。

Abstract:

Objective To observe the clinical efficacy of diffuse shock wave in the treatment of different types of postherpetic neuralgia. Methods 120 patients with postherpetic neuralgia admitted to our pain clinic from January 2017 to September 2018 were selected. According to the type of pain, they were divided into four groups (n = 30), irritable nociceptor type (group A): patients with abnormal sensitization of unmyelinated fibers show hyperalgesia; deafferentation type (group B): patients will have obvious loss of pain and temperature, mild tenderness is not obvious; central reorganization type (group C): both hyperalgesia type and paralysis type in clinical manifestations;normal nociceptor type (group D): patients have obvious pain in the affected area, clinical examination has no obvious changes in sensation or abnormal pain, All patients were treated with basic therapy: calcium channel regulation, opioids, neurotrophy, paravertebral nerve block, and diffuse shock wave once a week. Record the treatment time. The develop of Visual analogue scale (VAS) 、Hamilton Anxiety Scale (HAMA) and adverse reactions was before and 7 and 14 days after treatment.Results Compared with before treatment, the VAS score, HAMA total score, somatic anxiety factor total score and mental anxiety factor total score of the four groups decreased after 7 and 14 days of treatment (P < 0.05); compared with the irritable nociceptor type , the VAS score, HAMA total score, somatic anxiety factor total score and mental anxiety factor total score of the central reorganization type after 7 and 14 days of treatment had no significant difference (P ＞ 0.05).compared with the deafferentation type, the VAS score, HAMA total score, somatic anxiety factor total score and mental anxiety factor total score of the normal nociceptor type after 7 and 14 days of treatment had no significant difference (P ＞ 0.05). compared with irritable nociceptor type , VAS score, HAMA total score, somatic anxiety factor total score and mental anxiety factor total score of the normal nociceptor type and deafferentation type decreased 7 and 14 days after treatment (P<0.05); compared with central reorganization type, VAS score, HAMA total score, somatic anxiety factor total score and mental anxiety factor total score of the normal nociceptor type and deafferentation type decreased 7 and 14 days after treatment (P<0.05);Conclusion Diffuse shock wave can be used as an adjuvant therapy for postherpetic neuralgia, especially for irritable nociceptor type and central reorganization type postherpetic neuralgia in the long term, and improves the curative effect of conventional treatment.