背根神经节控温热凝术治疗不同病程阶段胸段带状疱疹后神经痛患者的疗效

Therapeutic effect of radiofrequency thermocoagulation to the Dorsal Root Ganglion on patients with thoracic postherpetic neuralgia at different stagesYan Ruhu, Zhang Wangao, Ding Yikun, Zong Huimin

摘要:

目的 探讨背根神经节(Dorsal Root Ganglion,DRG)控温热凝术在不同病程阶段胸段带状疱疹后神经痛(postherpetic neuralgia, PHN)的疗效。方法 收集2014年11月到2019年12月在安徽中医药大学第一附属医院介入疼痛科收治的不同病程阶段胸段带状疱疹后神经痛患者39例作为研究对象,既往口服常规推荐剂量的加巴喷丁或普瑞巴林联合非甾体类及阿片类镇痛药物时间超过1个月且效果不佳或不耐受,既往曾接受皮内阻滞、肋间神经阻滞及脉冲射频疗效不佳。患者年龄、性别、神经节段不限,初始VAS≥6；根据不同病程阶段将所有患者分为3组,第1组(1～3个月,n=13)、第2组(3～6个月,n=13)和第3组(大于6个月,n=13)。3组均给予 DRG 控温热凝进行治疗,出院后进行 3个月的随访。比较3组术前及术后3 d、1个月、3个月 VAS评分变化、治疗后各时点 VAS≤3例数及占比情况、治疗后总有效率及治疗不良反应的发生情况。结果 3组数据术后3d、1个月及3个月VAS评分与术前相比,VAS评分均明显下降,差异有统计学意义(P<0.05)。术后3个月与1个月时各组VAS评分与同组比较发现,3个月相比1个月时每个组的VAS评分均有显著下降,表明治疗有持久疗效。相比3组术后3 d、1个月及3个月VAS的下降幅度,第1组下降最显著,第2组次之,第3组最低,差异有统计学意义(P<0.05)。术后 3d、1个月及3个月时 VAS≤3占比情况,第1组例数最多,第2组次之,第3组最少。术后3个月时第1组和第2组有效率100%,第3组有效率46.2%。3 组患者均未出现严重不良反应。结论 DRG控温热凝治疗不同病程阶段胸段带状疱疹后神经痛,能有效缓解胸段PHN疼痛,病程越短,疗效越佳,应尽早应用于胸段PHN。

Abstract:

Objective To investigate the clinical effect of radiofrequency thermocoagulation(CRF) to the Dorsal Root Ganglion(DRG) on thoracic postherpetic neuralgia(PHN) at different stages. Methods 39 patients with thoracic PHN at different stages,from november 2014 to december 2019 in the Department of Intervention and Pain Medicine of First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, were collected as research subjects. Some of the patients had received regular doses of gabapentin or pregabalin combined with non-steroid and opiates analgesic drug lasted more than 1 month but with poor efficacy or non-tolerance, and some of them had received intradermal block, intercostal nerve block and Pulsed radiofrequency also with inefficacy． The patient"s age, gender and ganglion segments were not limited, and the initial values of VAS were ≥6 . All the patients were divided into 3 groups according to the course of CRF after PHN onset：group 1(within 3 months,n=13), group 2(between 3 and 6 months,n=13) and group 3(more than 6 months,n=13). All patients received CRF and followed up for 3 months after discharge. The VAS scores before CRF and at 3 days, 1 month, and 3 months after CRF, the number and proportion of VAS≤3 cases at different time points, the total effective rate, and the adverse reactions after CRF in all three groups were compared. Results The VAS at 3 days,1 months and 3 months after CRF were significantly lower than those before operation, and the difference was statistically significant (P <0.05). Compared the VAS scores of each group at 3 months and 1 month after operation with the same group, it was found that the VAS scores of each group at 3 months decreased significantly at 1 month, indicating that the treatment had a long-term effect. Comparing the decline in VAS at 3 days, 1 month and 3 months after operation in all 3 groups, group 1 had the most significant decrease, group 2 followed, group 3 had the lowest, and the difference was statistically significant (P <0.05). At 3 days, 1 month and 3 months after surgery, the proportion of VAS≤3 was the highest in the first group, followed by the second group, and the least in the third group. At 3 months after operation, the effective rate of group 1 and group 2 was 100%, and the effective rate of group 3 was 46.2%. There were no serious adverse reactions in all of 3 groups. Conclusion The CRF to the DRG can effectively relieve the pain of thoracic PHN at different stages. The shorter the duration of the disease, the better the curative effect, and it should be applied to thoracic PHN as soon as possible.