脉冲射频联合度洛西汀治疗合并焦虑抑郁老年带状疱疹后神经痛的疗效观察

Effect of pulsed radiofrequency combined with duloxetine in the treatment of postherpetic neuralgia in elderly patients with anxiety and depression

摘要:

目的 度洛西汀是一种5-羟色胺和去甲肾上腺素双重再摄取抑制剂,通过抑制中枢神经元对两种神经介质的再摄取起到镇痛效果,同时还可以改善睡眠质量,缓解焦虑抑郁程度,降低阿片类药物不良反应的发生率。本研究旨在评价与单纯脉冲射频(pulsed radiofrequency, PRF)相比,脉冲射频联合度洛西汀在治疗合并焦虑抑郁带状疱疹后神经痛(postherpetic neuralgia,PHN)患者中的治疗效果。方法 本研究是一项随机、对照、双盲研究中,于徐州医科大学附属医院招募年龄60岁以上、具有中重度疼痛的PHN患者,将患者随机分为脉冲射频组(PRF组)和脉冲射频联合度洛西汀组(D-PRF组)。分别在治疗前、治疗后1周、2周、1月、3月及6月时进行数字评分量表(visual analogue scale, NRS)、简明疼痛评估量表(self-rating scale of sleep, BPI)、患者健康问卷抑郁量表(patient health questionnaire-9,PHQ-9) 、广泛性焦虑障碍量表(generalized anxiety disorder-7, GAD-7) 评估,记录治疗后各个时间点的平均每日加巴喷丁及盐酸曲马多使用量,并于治疗后6月统计不良反应的发生率。结果 与治疗前相比,两组患者治疗后各时间点的NRS评分、BPI评分、GAD-7及PHQ-9评分均降低 (P < 0.05)；与PRF组相比,D-PRF组患者在治疗后同一时间点的NRS评分、BPI评分、GAD-7及PHQ-9改善情况均优于PRF组(P < 0.05)；治疗后D-PRF组在1周、2周、1月及3月的平均每日加巴喷丁及盐酸曲马多的使用量低于PRF组(P < 0.05),6月时曲马多使用量低于PRF组,加巴喷丁使用量比较差异无统计学意义(P＞0.05)；两组不良反应的发生率差异无统计学意义。结论 度洛西汀可安全有效的用于PHN患者,超声引导下PRF联合度洛西汀对于合并焦虑抑郁患者的治疗效果较单独使用PRF效果更佳。

Abstract:

Objective:Duloxetine is a dual reuptake inhibitor of serotonin and norepinephrine. It has an analgesic effect by inhibiting the reuptake of two nerve mediators by central neurons. In addition, it can improve sleep quality, relieve anxiety and depression, and reduce the incidence of adverse reactions to opioids. This study aims to evaluate the therapeutic effect of pulsed radiofrequency combined with duloxetine in the treatment of postherpetic neuralgia (PHN) patients with anxiety and depression compared with pulsed radiofrequency (PRF) alone. Methods:This study was a randomized, controlled, double-blind study. PHN patients over 60 years old with moderate and severe pain were recruited in the affiliated Hospital of Xuzhou Medical University. The patients were randomly divided into pulsed radio frequency group (PRF) and pulsed radio frequency combined with duloxetine group (D-PRF). The numerical score scale(NRS)、self-rating scale of sleep(BPI)、patient health questionnaire-9(PHQ-9) and generalized anxiety disorder-7(GAD-7) were evaluated before treatment, 1 week, 2 weeks, 1 month, 3 months and 6 months after treatment. The average daily dosage of gabapentin and tramadol hydrochloride was recorded at each time point after treatment, and the incidence of adverse reactions was counted 6 months after treatment. Results:Compared with pre-treatment, NRS, BPI, GAD-7 and PHQ-9 of the two groups decreased at each time point after treatment (P < 0.05). Compared with the PRF group, NRS, BPI, GAD-7 and PHQ-9 improvement after treatment in the D-PRF group were better than those in the PRF group (P < 0.05). The average daily dosage of gabapentin and tramadol at 1 week, 2 weeks, 1 month and 3 months after treatment was lower than that in PRF group, and the dosage of tramadol at 6 months was lower than that in PRF group, but there was no significant difference in the use of gabapentin between two groups (P > 0.05). There was no significant difference in the incidence of adverse reactions between two groups. Conclusion:Duloxetine is safe and effective in patients with PHN. Ultrasound-guided PRF combined with duloxetine is more effective than PRF alone in the treatment of patients with anxiety and depression.