射频温度和时长对带状疱疹后神经痛疗效影响的临床研究

CLINILAL STUDY OF ADJUSTING THE TEMPERATURE AND DURATION OF RADIOFREQUENCY IN THE TREATMENT OF POSTHERPETIC NEURALGIA

摘要:

目的：本研究观察调整射频温度和时长治疗带状疱疹后神经痛的疗效及安全性。方法：本研究采用前瞻性研究方法，选择2017年8月至2019年8月符合入选标准的胸部或腹部带状疱疹后神经痛患者160例，年龄50-89岁。用随机数字表法将病人分为：42℃+短时程组(n=40）、42℃+长时程组(n=40）、48℃+短时程组(n=40）、48℃+长时程组(n=40）。记录4组患者术前、术后、术后1月、术后3月时疼痛数字评分法(NRS)评分、总有效率(疼痛缓解 51%以上的患者占本组总人数的百分率)及显效率(疼痛缓解 76%以上的患者占本组总人数的百分率)、镇痛药物和钙通道调节剂普瑞巴林使用量。结果：4组患者术后各时间点NRS评分均较术前明显降低，差异有统计学意义(P＜0.05)。4组患者在术后1月，NRS评分各组间差异无统计学意义(P＞0.05)。术后3月，4组患者中48℃+短时程组NRS评分最低，差异有统计学意义(P＜0.01)。与42℃+短时程组相比，42℃+长时程组术后NRS评分稍高，差异有统计学意义(P＜0.01)。术后3月随访患者，42℃+短时程组患者疼痛治疗有效率100%、显效率22.5%，42℃+长时程组患者疼痛治疗有效率72.5%、显效率5%，48℃+短时程组患者疼痛治疗有效率95%、显效率42.5%，48℃+长时程组患者疼痛治疗有效率100%、显效率12.5%。4组患者中48℃+短时程组患者镇痛药使用量最小，与42℃+短时程组相比，差异有统计学意义(P＜0.05)。4组患者中48℃+短时程组患者普瑞巴林使用量最小，与42℃+短时程组相比，差异有统计学意义(P＜0.001)。结论:增加射频治疗温度至48℃和/或延长射频治疗时长至600s均能有效增加带状疱疹后神经痛的疗效，且射频温度调节至48℃更能长时间减轻带状疱疹后神经痛患者的疼痛。

Abstract:

Abstract Objective： The purpose of this study was to investigate the effect and safety of adjusting the temperature and duration of Pulsed Radiofrequency (PRF) in the treatment of postherpetic neuralgia. Methods：One hundred and sixty cases of postherpetic neuralgia in chest or abdomen were selected, aged from 50 to 89. The patients were randomly divided into four groups: 42℃+short term group (n = 40), 42℃+long term group (n = 40), 48℃+short term group (n = 40), 48℃+long term group (n = 40). The NRS score, total effective rate (the percentage of patients with more than 51% pain relief in this group) and significant efficiency (the percentage of patients with more than 76% pain relief in this group), analgesic drugs and calcium channel regulator Pregabalin were recorded. Results: The postoperative NRS scores of the four groups were significantly lower than that of the preoperative (P < 0.05). There was no significant difference in NRS scores among the four groups at 1 month after operation (P > 0.05). Three months after operation, the NRS score of 48℃+short-term group was the lowest among the four groups (P < 0.01). After 3 months follow-up, the effective rate of pain treatment was 100% and the significant rate was 22.5% in the 42℃+short-term group, 72.5% and 5% in the 42℃+long-term group, 95% and 42.5% in the 48℃+short-term group, 100% and 12.5% in the 48℃+long-term group. The use of analgesics in 48℃+short-term group was the least among the four groups (P < 0.05). The use of Pregabalin in 48℃+short-term group was the least among the four groups (P < 0.001). Conclusion: Increasing the temperature of radiofrequency therapy to 48 ℃ and / or prolonging the duration of radiofrequency therapy to 600 s can effectively increase the efficacy of postherpetic neuralgia. And RF temperature regulation to 48 ℃ can reduce the pain of patients with postherpetic neuralgia for even longer time.