超声引导下脉冲射频治疗三叉神经第一支带状疱疹神经痛的临床研究

Clinical study on the treatment of the first trigeminal herpes zoster neuralgia with pulse radiofrequency guided by ultrasound

摘要:

目的：观察超声引导下脉冲射频（pulsed radiofrequency，PRF）治疗三叉神经第一支（V1）急性期带状疱疹及带状疱疹后神经痛（postherpetic neuralgia，PHN）的临床疗效。方法：选择46例V1带状疱疹患者。根据带状疱疹发病后实施PRF的时间分为两组：早期PRF组（30天内）和PHN-PRF组（90天以上）。均行超声引导下脉冲射频治疗三叉神经第一支。采用视觉模拟评分（visual analogue scale, VAS）评定治疗前、治疗后1周、4周和12周的疼痛情况，同时记录镇痛药曲马多和普瑞巴林用量。用显效率评定临床疗效。结果：两组患者治疗前VAS评分对比，差异无统计学意义（P>0.05），但早期-PRF组治疗后1周、4周、12周VAS评分均显著低于PHN-PRF组，差异均有统计学意义（P<0.05）。早期-PRF组治疗后1周、4周、12周曲马多、普瑞巴林计量均显著低于PHN-PRF组，差异均有统计学意义（P<0.05）。早期-PRF组治疗后1周、4周、12周的显效率分别为92.31%、96.15%、96.15%，均显著高于PHN-PRF组（65.00%、75.00%、75.00%），差异均有统计学意义（P < 0.05）。结论：PRF是治疗V1支急性期带状疱疹及PHN的有效方法，尤其是对于早期V1带状疱疹患者，可明显减轻疼痛并能有效预防V1带状疱疹后神经痛的发生。

Abstract:

Objective: To study the clinical effect of ultrasound-guided pulsed radio frequency (PRF) in the treatment of acute herpes zoster and postherpetic neuralgia (PHN) in the first branch of the trigeminal nerve (V1). Methods: 46 cases of herpes zoster V1 were selected. Patients were divided into 2groups according to the timing of PRF after zoster onset: an early PRF group (within 30 days) and a PHN PRF group (more than 90 days). The first branch of trigeminal nerve was treated by pulsed radiofrequency.VAS was used to evaluate the pain score before treatment, 1 week, 4 weeks and 12 weeks after treatment. To evaluate the efficacy of PRF, the tramadol and pregabalin doses were recorded at 1, 4 and 12 weeks after PRF. The clinical efficacy was evaluated by apparent efficiency. Results: There was no significant difference in VAS score between the two groups before treatment (P > 0.05), but the VAS score of early PRF group was significantly lower than that of PHN-PRF group at 1, 4 and 12 weeks after treatment (P < 0.05). At the first week, the fourth week and the 12th week after the treatment, the tramadol or pregabalin dosage in the early PRF group was significantly lower than that in the PHN-PRF group (P < 0.05). The effective rates of early PRF group were 92.31%, 96.15% and 96.15% respectively, which were significantly higher than PHN-PRF group (65.00%, 75.00% and 75.00%) (P < 0.05).Conclusion: PRF is an effective method for the treatment of V1 acute herpes zoster and PHN, especially for the early patients with V1 herpes zoster, it can significantly reduce the pain and effectively prevent the occurrence of neuralgia after V1 herpes zoster.