CT引导下背根神经节脉冲射频联合电针围刺治疗颈段带状疱疹后神经痛的疗效观察

目的 观察CT引导下背根神经节脉冲射频联合电针围刺治疗颈段带状疱疹后神经痛的临床疗效。 方法 采用随机数字表法将88例颈段带状疱疹后神经痛患者分为对照组、电针组、脉冲射频组及联合组。4组患者均常规给予加巴喷丁、曲马多治疗，电针组在药物干预基础上给予电针围刺治疗；脉冲射频组在药物干预基础上给予CT引导下颈段背根神经节脉冲射频治疗；联合组则同时给予CT引导下颈段背根神经节脉冲射频及电针围刺治疗。于治疗前（即入组时）、治疗后15 d、治疗后30 d时分别观察各组患者疼痛程度及面积、心理情绪、生活质量改善情况。 结果 入组时4组患者疼痛视觉模拟评分（VAS）、汉密顿焦虑量表（HAMA）评分、汉密顿抑郁量表（HAMD）评分、皮肤疼痛面积及生活质量评估量表（QOL-SF36）评分组间差异均无统计学意义（P>0.05）。与入组时比较，电针组、脉冲射频组及联合组在治疗后15 d及1个月时，其疼痛VAS、HAMA、HAMD评分、皮肤疼痛面积、QOL-SF36评分均有明显改善（P<0.05）。治疗后15 d、1个月时，联合组患者疼痛VAS评分［分别为（2.59±1.01）分、（1.77±1.10）分］、HAMA评分［分别为（12.45±4.11）分、（11.31±3.82）分］、HAMD评分［分别为（20.22±6.50）分、（16.54±6.58）分］、皮肤疼痛面积［分别为（66.36±31.25）cm2、（53.68±29.89）cm2］及QOL-SF36评分［分别为（90.54±15.02）分、（101.95±19.84）分］与电针组、脉冲射频组及对照组比较，发现组间差异均具有统计学意义（P<0.05）。治疗后3个月时联合组患者加巴喷丁与曲马多使用量［分别为（1309.1±603.8）mg/d、（104.5±57.5）mg/d］均较电针组、脉冲射频组及对照组显著下降，组间差异均具有统计学意义（P<0.05）。 结论 CT引导下背根神经节脉冲射频联合电针围刺治疗颈段带状疱疹后神经痛疗效确切，且安全性高、并发症少、风险低，该联合疗法值得临床推广、应用。

Treating neuralgia after herpes zoster infection with pulsed radiofrequency electrotherapy combined with acupuncture or electroacupuncture

Objective To observe the clinical effect of pulsed radiofrequency electrotherapy combined with acupuncture or electroacupuncture in treating neuralgia after herpes zoster infection. Methods Eighty-eight patients were divided into a control group, an electroacupuncture group, a pulsed electrotherapy group and a combined group using a random number table. The 4 groups were routinely given gabapentin and tramadol, while the electroacupuncture group was additionally treated with electroacupuncture, the pulsed electrotherapy group received radiofrequency irradiation of the dorsal root ganglion, and the combined group was given CT-guided pulsed radiofrequency electrotherapy combined with electroacupuncture or acupuncture. Before the treatment and 15 days and 1 month afterward, everyone was evaluated using a visual analogue scale (VAS) for pain intensity, the Hamilton anxiety (HAMA) and depression (HAMD) scales and the short form 36 (QOL-SF36) quality of life assessment. The area of painful skin was also measured. Results There were no significant differences among the 4 groups at the outset in any of the measurements. Significant improvement was observed in all of the measurements 15 and 30 days after the treatment except in the control group. The combined group was by then significantly better than the other 3 groups. Their dosage of gabapentin and tramadol had decreased significantly compared with the other groups after 3 months of treatment. Conclusion CT-guided pulsed radiofrequency electrotherapy combined with acupuncture or electroacupuncture is safe and effective for treating post-herpes neuralgia. It is worthy of clinical application and promotion.