【作者】 王波；

【导师】 冯智英；

【作者基本信息】 浙江大学 ， 麻醉学， 2018， 硕士

【摘要】 目的:比较不同射频电压下双极模式脉冲射频术治疗急性期带状疱疹性神经痛的疗效及安全性。方法:选择60例急性期带状疱疹性神经痛成年患者行双极脉冲射频术治疗疼痛。计算机断层扫描引导下穿刺,使2根射频针针尖到达受累神经椎间孔的中上方,随后进行感觉和运动测试,明确射频针针尖接近于背根神经节,在启动脉冲射频前将患者随机分为标准组和高压组,每组30例患者,标准组射频电压设定为50 V,高压组射频电压由50V起步,并逐渐提高直到患者最大耐受程度,其余射频参数均为:温度42℃,脉宽20 ms,频率2 Hz,时间480 s。所有患者均予以甲钴胺和鼠神经生长因子营养神经,并依据患者疼痛程度调整加巴喷丁用量以及使用曲马多。记录两组患者术前及术后第1周、2周、3周、4周的简式疼痛问卷表中感觉类疼痛分级指数评分(PRI-S)、情感类疼痛分级指数评分(PRI-A)、疼痛数字评价量表(NRS)、现时疼痛强度评分(PPI)、睡眠质量评分(SQ)、加巴喷丁周用量以及曲马多使用情况,记录两组患者一般情况、脉冲射频术中感觉测试电压、射频电阻、射频电压以及术后不良反应。结果:两组患者性别比、年龄、发病部位、发病时程以及重要合并症比较差异无统计学意义(P>0.05)。两组患者脉冲射频术中感觉测试电压、射频电阻比较差异无统计学意义(P>0.05),两组患者术后第1-4周的PRI-S、PRI-A、NRS、PPI均较术前明显降低(P<0.05);两组患者术后第1-4周的SQ均较术前明显升高(P<0.05)。高压组患者脉冲射频术中射频电压明显高于标准组(P<0.05);高压组患者术后第1-4周的PRI-S、PRI-A、NRS、PPI明显低于标准组(P<0.05);高压组患者术后第1周的SQ明显高于标准组(P<0.05);高压组患者术后第3、4周的加巴喷丁周用量明显少于标准组(P<0.05)。两组患者均未发现明显不良反应。结论:与标准电压模式相比,高电压下双极脉冲射频术显著提高急性期带状疱疹神经痛治疗效果,减少患者加巴喷丁用药量,提高患者生活质量,无明显不良反应。更多还原

【Abstract】 Objectives:To compared the clinical efficacy and safety of different voltage bipolar pulsed radio frequency for the treatment of acute zoster-associated pain.Methods:A total of sixty adult patients in the acute herpes zoster,two pulsed radiofrequency trocars were carefully inserted until the needle tip reached the middle-upper edge of the intervertebral foramen with the computed tomography(CT)guidance,ensured the needle tip in close proximity to the dorsal root ganglion(DRG)by the sensation and exercise test,divided into the standard voltage group and the high voltage group randomly before starting bipolar pulsed radiofrequency.For the standard voltage group,the output voltage was 50 V,and for the high voltage group,the output voltage increased gradually until the maximum voltage(bearable without causing pain in conscious patients),the remaining parameters were pulse temperature of 42℃and pulse duration of 20 ms and pulse rate of 2 Hz and pulse time of 480 s.Adjust the doses of gabapentin and combined with tramadol based on the patients’ tolerance degree of pain.The therapeutic effects were evaluated using the PRI-S and PRI-A of the short-form of McGill pain questionnaire(SF-MPQ),numerical rating scale(NRS),present pain intensit(PPI),sleep quality(SQ),the weekly doses of gabapentin and the numbers of patients use tramadol before PRF and 1,2,3,4weeks after PRF,observed the sensation test voltage,resistance and out-voltage in PRF and the adverse reactions after PRF.Results:The general conditions were no significantly differences between the two groups.the sensation test voltage and resistance in PRF were also no significant differences between the two groups.There were significant decrease in the PRI-S、PRI-A、NRS、PPI and increase in the SQ in both groups at 1,2,3,and 4 weeks after PRF(P<0.05).However,this decrease was more significant in the high voltage PRF group than in the standard voltage PRF group.The PRF voltage was higher in the high voltage PRF group than in the standard voltage PRF group(P<0.05),the SQ was higher in the high voltage PRF group than in the standard voltage PRF group at 1 week after PRF(P<0.05),the weekly doses of gabapentin decreased significantly in the high voltage PRF group than in the standard voltage PRF group at 3 and 4 weeks after PRF(P<0.05).No adverse reactions were identified after PRF in two groups.Conclusion:Compared to the standard voltage group,the high voltage bipolar pulsed radiofrequency was effective and safe for the treatment of acute zoster-associated pain,decreased the doses of gabapentin,improved the quality of life,and no adverse reactions were occurred.更多还原