改良脉冲射频星状神经节治疗带状疱疹后神经痛的近期临床观察

THE SHORT-TERM EFFECTS OF MODIFIED THERAPY OF PULSED RADIOFREQUENCY ON STELLATE GANGLION FOR POSTHERPETIC NEURALGIA

摘要:

目的：观察改良脉冲射频星状神经节治疗头面颈或上肢带状疱疹后神经痛（PostherpeticNeuralgia,PHN）的近期疗效及安全性。方法：40位头面颈或上肢PHN患者，4分≤VAS≤8分，随机分为两组，射频组(n=20)在超声引导下于C7水平选择3个靶点脉冲射频星状神经节。对照组(n=20)实施同样操作，但不发射脉冲电流治疗。两组术后第48h均行视觉模拟评分 (visual analogue scale, VAS)，VAS≥4分时口服加巴喷丁使VAS≤3分。治疗前、治疗后24h、48h行VAS;治疗后1周、1月和3月记录加巴喷丁日摄取量;治疗前、治疗后1月、3月行匹兹堡睡眠质量指数 (pittsburgh sleep quality index, PSQI)评分、简明健康调查问卷(the MOS item short from health survey，SF-36)评分，比较两组各指标改善情况。结果：VAS：射频组治疗后第24h、48h，均较治疗前明显降低(P<0.05)；与对照组比较，差异有统计学意义(P<0.05)。对照组治疗后与其治疗前比较，差异没有统计学意义。加巴喷丁日摄取量：治疗后1周、1月，射频组较对照组均少(P<0.05)；治疗后3月两组比较差异无统计学意义。PSQI评分、SF-36评分：与治疗前比较，治疗后两组均明显改善；治疗后1月射频组改善优于对照组(P<0.05)；治疗后3月，两组间比较，差异无统计学意义。治疗期间中未发现严重并发症。结论：改良脉冲射频星状神经节短期内可有效缓解头面颈或上肢带状疱疹后神经痛。

Abstract:

Objective:To observe the short-term efficacy and safety of modified therapy of pulsed radiofrequency (PRF)on the stellate ganglion for treating Post Herpetic Neuralgia（PHN）in the head, face, neck or upper limb. Methods: 40 cases of PHN in the head,face,neck or upper limb with 4 points≤VAS≤8 points，were randomly divided into radiofrequency group (RF,n=20) and sham group(n=20). Under the guidance of ultrasound, the RF group received PRF on three different targets around the C7 process level. The patients were given oral gabapentin to make VAS ≤ 3 points if the VAS≥4 since 48h of post-PRF therapy. The sham group received the similar procedure without transmitting pulsed current. On 48h after the procedure, gabapentin was also given to make VAS≤3 points. VAS was assayed before procedure，on 24h and 48h after procedure. Daily gabapentin consumption was recorded in the 1st week,the 1st month and the 3rd month after procedure. Pittsburgh Sleep Quality Index (PSQI) score and the MOS item short from health survey (SF-36) score were performed before procedure,the 1st month and the 3rd month after procedure. Results: VAS of the RF group decreased significantly on the 24h and 48h after procedure (P<0.05), and the advantage was statistically significant compared with sham group(P<0.05).However, compared with pre-treatment,there were no significant differences on the 24h and 48h after procedurein sham group. Daily gabapentin consumption in RF group were lower than those in sham group on the 1st week and 1st month after procedure (P<0.05).Yet,there were no significant differences between the two groups on the 3rd month after procedure. PSQI scores and SF-36 scores in the two groups were both significantly improved after treatment, but the improvement in RF group took advantage over that in sham group on the 1stmonth after procedure (P<0.05). On the 3rd month after procedure, there were no statistical differences between the two groups. No serious complications were observed during the whole treatment. Conclusions:Modified PRF on stellate ganglion can effectively relieve PHN in the head，face，neck or upper limb in a short-term.