超声引导肋间神经射频热凝联合神经阻滞术治疗带状疱疹后神经痛的临床研究

摘要

目的 探讨超声引导下肋间神经射频热凝术加神经阻滞治疗胸背腹部带状疱疹后神经痛的临床疗效.方法 选择符合纳入和排除标准的带状疱疹后神经痛患者60例,随机分为两组,每组30例,RF组为超声引导下肋间神经射频热凝加神经阻滞组,NB组为超声引导下肋间神经阻滞组.观察治疗前、治疗后即刻、1周、1个月、3个月及6个月的视觉模拟评分(VAS)、匹兹堡睡眠质量指数(PSQI)、焦虑和抑郁评分,比较两组指标的统计学差异.结果 两组VAS评分、PSQI总分、焦虑、抑郁评分,治疗后均较治疗前明显下降,差异有统计学意义(P<0.05).治疗后即刻、1周、1个月,两组的VAS评分、PSQI总分、焦虑、抑郁评分的比较,差异无统计学意义(P>0.05),治疗后3个月、6个月,RF组的VAS评分优于NB组,差异有统计学意义(P<0.05).未发生气胸、呼吸困难、血气胸及出血等并发症.结论 超声引导下肋间神经射频热凝联合神经阻滞术治疗胸背腹部带状疱疹后神经痛安全有效,且中长期临床疗效优于单用神经阻滞.%Objective To discuss the efficacy of ultrasonography guided radiofrequency thermocoagulation of the intercos-tal nerve combined with nerve blockade on thoracic,back and abdominal postherpetic neuralgia. Methods 60 patients with postherpetic neuralgia who met inclusion and exclusion criteria were admitted,and randomized into two groups,and each group in-cludes 30 patients.RF group was ultrasonography guided radiofrequency thermocoagulation of the intercostal nerve combined with nerve blockade,and NB group were ultrasonography guided intercostal nerve blockade. Observe the pretreatment,immediately, 1-week,1-month,3-month and 6month posttreatment visual analog scale(VAS),Pittsburgh sleep quality index(PSQI),and the score of the anxiety or depression,to compare the statistical differences of the two groups' data.Results The posttreatment VAS, PSQI and score of anxiety or depression of both two groups were obviously decreased compared with pre-treatment(P<0.05). There were no significant statistical difference on immediately,1-week and 1-month posttreatment VAS,PSQI and score of anxiety or depression between two groups(P>0.005),and the 3-month and 6-month posttreatment VAS of RF group were better than NB group (P<0.005).Complications such as pneumothorax,dyspnea,hemopneumothorax and bleeding did not happen.Conclusion Ultra-sonography guided radiofrequency thermocoagulation of the intercostal nerve combined with nerve blockade is safe and effective on thoracic,back and abdominal postherpetic neuralgia,and have a better medium-and long-term clinical efficacy than treatment by nerve blockade only.