【摘要】 目的探讨高频重复经颅磁刺激(rTMS)不同靶点治疗带状疱疹后遗神经痛(PHN)的疗效。方法 PHN患者60例,病程6~12个月,均分为前额叶背外侧皮质(DLPFC)区组(DLPFC组)、初级运动皮质(M1)区组(M1组)和假刺激组。DLPFC组在左侧大脑DLPFC区给予rTMS,M1组在疼痛对侧大脑M1区给予rTMS,假刺激组在头顶中心点(脑电图CZ点)给予假刺激。rTMS参数:频率10Hz,强度80%静息运动阈值,刺激5s,间歇3s。共300个串1500次脉冲。每周5次,连续治疗4周。比较三组治疗前后VAS疼痛评分、匹兹堡睡眠质量指数(PSQI)、焦虑自评量表(SAS)和抑郁自评量表(SDS)评分。结果治疗4周后,DLPFC组、M1组VAS疼痛、PSQI、SAS和SDS评分均较假刺激组及治疗前改善(P<0.05);DLPFC组PSQI评分和SAS评分均优于M1组[(4.9±1.4)分vs.(6.4±2.2)分和(44.4±8.7)分vs.(49.8±8.0)分](P<0.05)。结论大脑M1区和DLPFC区的高频rTMS对PHN均有疗效;其中,DLPFC区作为刺激靶点对患者睡眠和焦虑症状的改善更明显。更多还原

【Abstract】 Objective To compare the effects of high frequency repetitive transcranial magnetic stimulation(rTMS)by stimulating over different target points in the patients with postherpetic neuralgia(PHN).Methods Sixty patients with PHN(6to 12 months after onset)were assigned randomly and equally into three groups of M1(stimulating M1 area of the unaffected hemisphere of the primary motor cortex),DLPFC(stimulating the dorsolateral prefrontal cortex area)and S(shamly stimulating EEG CZ point).All patients underwent conventional drug treatments.The parameters of rTMS were frequency 10 Hz,intensity 80% of resting motor threshold.The stimulation was performed with a total of 1500 pulses per day(300trains of 5sstimulus and 3sinterval),5times per week for 4weeks.The VAS pain score,Pittsburgh sleep quality index(PSQI),self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were evaluated before and after treatment.Results The VAS pain score,PSQI,SAS and SDS in groups of M1 and DLPFC were all improved 4 weeks after treatment compared to pre-treatment and group S(P<0.05).The scores of PSQI and SAS were better in group DLPFC than those in group M1[(4.9±1.4)points vs.(6.4±2.2)points and(44.4±8.7)points vs.(49.8±8.0)points](P<0.05).Conclusion The high frequency rTMS in M1 area of the unaffected hemisphere of the primary motor cortex and the left dorsolateral prefrontal cortex area is effective in the patients with PHN.It is better to stimulate the left dorsolateral prefrontal cortex area for the improvements of sleep quality,anxiety and depression.更多还原