带状疱疹神经痛短时程脊髓电刺激术后病人服药依从性与镇痛效果的相关调查

Investigation the relevant of postoperative medication compliance and analgesic effect in patients of herpes zoster neuralgia after spinal cord stimulation

摘要:

目的：本研究将对带状疱疹性神经痛（herpes zosterneuralgia，HZN）短时程脊髓电刺激术（short-term spinal cord stimulation, st-SCS）术后的患者进行研究，了解患者出院当天、1周、1个月、3个月的服药依从性和镇痛效果得分，分析患者服药依从性与镇痛效果的关联，确定st-SCS术后患者镇痛效果与服药依从性的关系，为带状疱疹性神经痛患者st-SCS治疗后出院延续性护理工作要点提供依据，以便制定合理的提高服药依从性的相关护理措施，为其他研究者提供参考。方法：本研究为纵向研究，随机抽取91例PHN行st-SCS术后病人，对出院后已拔除st-SCS的病人进行电话随访，调查其出院当天、1周、1个月、3个月后的服药依从性情况、疼痛程度。运用普适性药物依从性量表 (general medication adherence scale, GMAS)、疼痛数字分级评分法 (numerical rating scale, NRS)进行数据收集，进行Spearman秩相关分析以确定服药依从性与疼痛控制效果相关性。结果：Spearman秩相关分析显示，带状疱疹性神经痛患者出院当天、1周、1个月、3个月，服药依从性与NRS评分呈负相关（r = -0.462 ~ -0.704, P<0.05）。结论：术后患者的服药依从性与镇痛效果正相关，患者出院后服药依从性越好，即出院后的镇痛效果越好。提高患者服药依从性可使患者出院后镇痛效果更好、更持久，减少疼痛复发率。

Abstract:

Objective:This study evaluated medication adherence and analgesic efficacy in patients with herpes zoster neuralgia (HZN) treated by short-term spinal cord stimulation (st-SCS), assessing outcomes at discharge and at 1 week, 1 month, and 3 months post-discharge. We analyzed the association between adherence and pain relief to inform continuity-of-care strategies and guide the development of targeted nursing interventions. Methods:In this longitudinal cohort, 91 post-herpetic neuralgia patients undergoing st-SCS were enrolled. After device explantation, participants were followed by telephone at discharge, 1 week, 1 month, and 3 months to document medication adherence (General Medication Adherence Scale, GMAS) and pain intensity (11-point Numerical Rating Scale, NRS). Spearman’s rank-order correlation was used to assess the relationship between adherence and analgesic efficacy.Results:Spearman analysis demonstrated a significant inverse correlation between GMAS and NRS scores at all time points: discharge day (r = –0.462; P < 0.001), 1 week (r = –0.587; P < 0.001), 1 month (r = –0.658; P < 0.001), and 3 months (r = –0.704; P < 0.001), indicating a moderate to strong association.Conclusions: Post-discharge medication adherence is strongly associated with sustained pain relief in HZN patients treated with st-SCS. Implementing adherence-enhancing strategies may optimize long-term analgesic outcomes and reduce pain recurrence. Future research should investigate specific interventions to further improve adherence and clinical benefit.