CT引导下臭氧联合脉冲射频治疗带状疱疹后神经痛的疗效及对血清炎性因子的影响
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摘要
目的观察在CT引导下背根神经节臭氧注射联合脉冲射频对老年患者带状疱疹后神经痛(PHN)的疗效、安全性及对血清肿瘤坏死因子(TNF)-α和白细胞介素(IL)-6水平的影响。方法将75例老年PHN患者随机分为A、B、C三组,各25例,在CT引导下A组给予臭氧注射治疗,B组给予脉冲射频治疗,C组给予臭氧注射联合脉冲射频治疗,三组在出现爆发痛时均口服吗啡即释片10mg。观察各组患者治疗前后的视觉模拟评分(VAS)、抑郁自评量表(SDS)评分和焦虑自评量表(SAS)评分及治疗后并发症,测定治疗前后血清炎性因子TNF-α、IL-6水平,并记录吗啡摄取量。结果治疗后3天、7天、30天、90天三组VAS评分均较治疗前降低,且在治疗后7天、30天、90天C组明显低于A、B两组(P<0.05);治疗后第1周、第4周、第8周及第12周内吗啡摄取量C组明显低于A、B两组(P<0.05);治疗后30天三组SDS、SAS评分均较治疗前降低,各组间差异无统计学意义(P>0.05);三组治疗后7天血清TNF-α、IL-6水平均较治疗前降低,且C组较A、B两组显著降低(P<0.05);三组患者治疗后均未出现严重并发症。结论 CT引导下背根神经节臭氧注射联合脉冲射频治疗老年患者PHN临床疗效确切,可减轻患者疼痛症状,减少止疼药物用量,并促进炎性因子平衡,且对于长期疼痛引起的焦虑及抑郁症状有明显的改善作用。
Objective To investigate the effect and its safety of ozone injection combined with pulsed radiofrequency in dorsal root ganglion under CT guidance in the treatment of elderly patients with postherpetic neuralgia(PHN), and effect on serum TNF-α and IL-6 levels. Methods Seventy-five patients with PHN were randomly divided into three groups: A, B and C(25 cases in each group). Under CT guidance, group A was given ozone injection therapy, group B was given pulsed radiofrequency therapy, and group C was given ozone injection combined with pulsed radiofrequency, patients received 10 mg morphine for bursting pain. Visual analogue scale(VAS) scores, depression self-rating scale(SDS) scores, anxiety self-rating scale(SAS) scores, post-treatment complications and the levels of serum TNF-α and IL-6 were measured before and after treatment, and the consumption of morphine was recorded. Results The VAS scores of all groups at 3 d, 7 d, 30 d and 90 d after treatments were lower than before, and group C was significantly lower than group A and B at 7 d, 30 d and 90 d after treatment(P<0.05). Compared with group A and B, the consumption of morphine in the first week, the 4 th week, the 8 th week and the 12 th week after treatment was significantly lower in group C(P<0.05). The SAS and SDS scores of all groups were lower than before and there were no differences among them(P>0.05). The levels of serum TNF-α and IL-6 decreased after treatment in all groups, and group C decreased significantly compared with group A and B(P<0.05). Serious complications were not found in all groups after treatments. Conclusion Ozone injection combined with pulsed radiofrequency in dorsal root ganglion under CT guidance in the treatment of elderly patients with PHN has definite clinical effect, which can alleviate the pain symptoms, reduce the amount of pain medication, promote the balance of inflammatory factors, and significantly improve the anxiety and depressive symptoms caused by long-term pain.
Objective To investigate the effect and its safety of ozone injection combined with pulsed radiofrequency in dorsal root ganglion under CT guidance in the treatment of elderly patients with postherpetic neuralgia(PHN), and effect on serum TNF-α and IL-6 levels. Methods Seventy-five patients with PHN were randomly divided into three groups: A, B and C(25 cases in each group). Under CT guidance, group A was given ozone injection therapy, group B was given pulsed radiofrequency therapy, and group C was given ozone injection combined with pulsed radiofrequency, patients received 10 mg morphine for bursting pain. Visual analogue scale(VAS) scores, depression self-rating scale(SDS) scores, anxiety self-rating scale(SAS) scores, post-treatment complications and the levels of serum TNF-α and IL-6 were measured before and after treatment, and the consumption of morphine was recorded. Results The VAS scores of all groups at 3 d, 7 d, 30 d and 90 d after treatments were lower than before, and group C was significantly lower than group A and B at 7 d, 30 d and 90 d after treatment(P<0.05). Compared with group A and B, the consumption of morphine in the first week, the 4 th week, the 8 th week and the 12 th week after treatment was significantly lower in group C(P<0.05). The SAS and SDS scores of all groups were lower than before and there were no differences among them(P>0.05). The levels of serum TNF-α and IL-6 decreased after treatment in all groups, and group C decreased significantly compared with group A and B(P<0.05). Serious complications were not found in all groups after treatments. Conclusion Ozone injection combined with pulsed radiofrequency in dorsal root ganglion under CT guidance in the treatment of elderly patients with PHN has definite clinical effect, which can alleviate the pain symptoms, reduce the amount of pain medication, promote the balance of inflammatory factors, and significantly improve the anxiety and depressive symptoms caused by long-term pain.
引文
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3 Shi Y,Wu W.Treatment of Neuropathic Pain Using Pulsed Radiofrequency:A Meta-analysis[J].Pain Physician,2016,19(7):429-444
4李爱香,李国军,王建荔.医用臭氧治疗老年带状疱疹神经痛患者的疗效和安全性[J].上海医学,2012,35:8
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9 Saxena AK,Lakshman K,Sharma T,et al.Modulation of serum BDNF levels in postherpetic neuralgia following pulsed radiofrequency of intercostal nerve and pregabalin[J].Pain Manag,2016,6(3):217-227
10 Lin Q,Chen H,Lu C,et al.Effects of ozone on sciatic nerve in rat[J].Interventional Neuroradiology Journal of Peritherapeutic Neuroradiology Surgical Procedures&Related Neurosciences,2011,17(3):281-285
11 Bocci V,Borrelli E,Zanardi I,et al.The usefulness of ozone treatment in spinal pain[J].Drug Des Devel Ther,2015,9:2677-2685
12 Xing Q,Hu D,Shi F,et al.Role of regulatory T cells in patients with acute herpes zoster and relationship to postherpetic neuralgia[J].Archives of Dermatological Research,2013,305(8):715-722
13带状疱疹后神经痛诊疗共识编写专家组.带状疱疹后神经痛诊疗中国专家共识[J].中国疼痛医学杂志,2016,22(3):161-167
14 Bayat A,Burbelo PD,Browne SK,et al.Anti-cytokine autoantibodies in postherpetic neuralgia[J].Journal of Translational Medicine,2015,13(1):333
15 Raghavendra V,Rutkowski MD,Deleo JA.The role of spinal neuroimmune activation in morphine tolerance/hyperalgesia in neuropathic and sham-operated rats[J].Journal of Neuroscience,2002,22(22):9980-9989
16 Zou J,Vetreno RP,Crews FT.ATP‐P2X7 receptor signaling controls basal and TNFα‐stimulated glial cell proliferation[J].Glia,2012,60(4):661-673
17王英,曾德敏,谢平,等.脉冲射频联合臭氧注射治疗腰脊神经后支痛的临床疗效研究[J].中国疼痛医学杂志,2017,23(9):699-701
2 Kawai K,Gebremeskel BG,Acosta CJ.Systematic review of incidence and complications of herpes zoster:towards a global perspective[J].Bmj Open,2014,4(6):e004833
3 Shi Y,Wu W.Treatment of Neuropathic Pain Using Pulsed Radiofrequency:A Meta-analysis[J].Pain Physician,2016,19(7):429-444
4李爱香,李国军,王建荔.医用臭氧治疗老年带状疱疹神经痛患者的疗效和安全性[J].上海医学,2012,35:8
5 Johnson RW,Rice ASC.Postherpetic Neuralgia[J].New England Journal of Medicine,2014,371(16):1526-1533
6 Li D,Sun G,Sun H,et al.Combined therapy of pulsed radiofrequency and nerve block in postherpetic neuralgia patients:a randomized clinical trial[J].Peerj,2018,6(6):e4852
7 Mu?oz-Quiles C,López-Lacort M,Orrico-Sánchez A,et al.Impact of Postherpetic Neuralgia:A six year Population-Based analysis on people aged 50 years or older[J].Journal of Infection,2018,77(2):131-136
8 Park HW,Ahn SH,Son JY,et al.Pulsed radiofrequency application reduced mechanical hypersensitivity and microglial expression in neuropathic pain model[J].Pain Medicine,2012,13(9):1227-1234
9 Saxena AK,Lakshman K,Sharma T,et al.Modulation of serum BDNF levels in postherpetic neuralgia following pulsed radiofrequency of intercostal nerve and pregabalin[J].Pain Manag,2016,6(3):217-227
10 Lin Q,Chen H,Lu C,et al.Effects of ozone on sciatic nerve in rat[J].Interventional Neuroradiology Journal of Peritherapeutic Neuroradiology Surgical Procedures&Related Neurosciences,2011,17(3):281-285
11 Bocci V,Borrelli E,Zanardi I,et al.The usefulness of ozone treatment in spinal pain[J].Drug Des Devel Ther,2015,9:2677-2685
12 Xing Q,Hu D,Shi F,et al.Role of regulatory T cells in patients with acute herpes zoster and relationship to postherpetic neuralgia[J].Archives of Dermatological Research,2013,305(8):715-722
13带状疱疹后神经痛诊疗共识编写专家组.带状疱疹后神经痛诊疗中国专家共识[J].中国疼痛医学杂志,2016,22(3):161-167
14 Bayat A,Burbelo PD,Browne SK,et al.Anti-cytokine autoantibodies in postherpetic neuralgia[J].Journal of Translational Medicine,2015,13(1):333
15 Raghavendra V,Rutkowski MD,Deleo JA.The role of spinal neuroimmune activation in morphine tolerance/hyperalgesia in neuropathic and sham-operated rats[J].Journal of Neuroscience,2002,22(22):9980-9989
16 Zou J,Vetreno RP,Crews FT.ATP‐P2X7 receptor signaling controls basal and TNFα‐stimulated glial cell proliferation[J].Glia,2012,60(4):661-673
17王英,曾德敏,谢平,等.脉冲射频联合臭氧注射治疗腰脊神经后支痛的临床疗效研究[J].中国疼痛医学杂志,2017,23(9):699-701