脉冲射频治疗带状疱疹后神经痛临床效果的系统评价
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摘要
目的:评价脉冲射频治疗带状疱疹后神经痛的镇痛效果及有效性,为临床治疗提供参考。方法:数据库检索Pub Med、The Cochrane Library、CNKI、VIP、Wan Fang Data、中国生物医学文献数据库,时限从1997年1月1日至2016年10月1日。根据纳入排除标准,收集脉冲射频治疗带状疱疹后神经痛的随机对照试验,依据Cochrane Handbook 5.1.0偏倚风险评估工具评价纳入文献质量,文献数据用Revman 5.3软件进行Meta分析。结果:最终21项随机对照试验纳入研究,共1463名受试者。Meta分析结果表明:脉冲射频组比对照组有更好的镇痛效果,同时有更高的有效率、显效率和优良率,统计结果有显著性意义。结论:与传统方法相比,脉冲射频治疗6个月内临床效果更好,且术后并发症少,是理想的治疗方法,但远期效果需进一步探讨。
Objective: To evaluate the analgesic effect and effectiveness of pulsed radiofrequency(PRF) on postherpetic neuralgia(PHN) and to provide the basis and the reference for clinical treatment. Method: A systematic and comprehensive database search was performed in Pub Med, The Cochrane Library, China National Knowledge Infrastructure(CNKI), China Science and Technology Journal Database(VIP), Chinese Biomedical Literature Database, and Wanfang database for literatures published since January 1, 1997 to October 1, 2016. According to inclusion and exclusion criteria, randomized controlled trials presenting PRF for PHN treatment were collected. The risk of bias tool described in the Cochrane Handbook version 5.1.0 was used to assess the quality of each trial. Meta-analysis was performed using RevMan 5.3 software. Results: A total of twenty-one randomized controlled trials involving 1 463 patients met inclusion criteria. The results of meta-analysis showed that, compared with the control group, PRF had a better effect on pain score, effective rate, marked effective rate, excellent and good rate. Conclusion: Compared with the traditional method, PRF shows an obvious analgesic effect and a lower incidence of adverse reaction for the treatment of PHN in 6 months. It is an ideal method for the treatment of PHN, but long-term effects need to be further discussed.
Objective: To evaluate the analgesic effect and effectiveness of pulsed radiofrequency(PRF) on postherpetic neuralgia(PHN) and to provide the basis and the reference for clinical treatment. Method: A systematic and comprehensive database search was performed in Pub Med, The Cochrane Library, China National Knowledge Infrastructure(CNKI), China Science and Technology Journal Database(VIP), Chinese Biomedical Literature Database, and Wanfang database for literatures published since January 1, 1997 to October 1, 2016. According to inclusion and exclusion criteria, randomized controlled trials presenting PRF for PHN treatment were collected. The risk of bias tool described in the Cochrane Handbook version 5.1.0 was used to assess the quality of each trial. Meta-analysis was performed using RevMan 5.3 software. Results: A total of twenty-one randomized controlled trials involving 1 463 patients met inclusion criteria. The results of meta-analysis showed that, compared with the control group, PRF had a better effect on pain score, effective rate, marked effective rate, excellent and good rate. Conclusion: Compared with the traditional method, PRF shows an obvious analgesic effect and a lower incidence of adverse reaction for the treatment of PHN in 6 months. It is an ideal method for the treatment of PHN, but long-term effects need to be further discussed.
引文
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[17]黎飞,张娟娟,沈欢,等.脉冲射频联合得保松治疗带状疱疹后神经痛的疗效观察.安徽卫生职业技术学院学报,2013,12(4):43~44.
[18]张伟波.脉冲射频联合肋间神经阻滞治疗老年人胸背部带状疱疹后神经痛.浙江大学,2013.
[19]付强,郑宝森.脉冲射频治疗老年带状疱疹后神经痛的疗效及对血清肿瘤坏死因子-α和白细胞介素-1β水平的影响.中国老年学,2016(4):931~932.
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[22]张彩琳,李亦梅.脉冲射频调节与神经阻滞治疗带状疱疹后神经痛的临床疗效观察.继续医学教育,2017,31(4):105~107.
[23]凌地洋,王哲银,卢振和,等.选择性背根神经节脉冲射频术联合普瑞巴林治疗带状疱疹后神经痛的临床观察.中国疼痛医学杂志,2013,19(10):587~591.
[24]犹云德,付德佳,余红亚.脉冲射频配合神经阻滞治疗带状疱疹后遗神经痛30例.实用心脑肺血管病杂志,2011,19(3):477~477.
[25]汪为刚,侯枫林.脉冲射频术治疗难治性胸段带状疱疹后遗神经痛疗效观察.按摩与康复医学,2014(3):121~122.
[26]Saxena AK,Lakshman K,Sharma T,et al.Modulation of serum BDNF levels in postherpetic neuralgia following pulsed radiofrequency of intercostal nerve and pregabalin.Pain Management,2016,6(3):217.
[27]黄宇光,徐建国.神经病理性疼痛临床诊疗学.2010.
[28]Johnson RW,Wasner G,Saddier P,et al.Postherpetic neuralgia:epidemiology,pathophysiology and management.Expert Review of Neurotherapeutics,2007,7(11):1581.
[29]赵志奇.带状疱疹痛:基础和临床概述.中国疼痛医学杂志,2014,20(6):369~375.
[30]于生元,万有,万琪,等.带状疱疹后神经痛诊疗中国专家共识.中国疼痛医学杂志,2016,22(3):161~167.
[2]Erdine S,Bilir A,Cosman ER,et al.Ultrastructural changes in axons following exposure to pulsed radiofrequency fields.Pain Practice,2009,9(6):407~417.
[3]神经病理性疼痛诊疗专家组.神经病理性疼痛诊疗专家共识.中国疼痛医学杂志,2013,19(12):705~710.
[4]魏星,王家双,包佳巾.脉冲射频用于三叉神经疱疹后神经痛治疗的对比观察.中国疼痛医学杂志,2011,17(4):205~207.
[5]Ke M,Yinghui F,Yi J,et al.Efficacy of pulsed radiofrequency in the treatment of thoracic postherpetic neuralgia from the angulus costae:a randomized,double-blinded,controlled trial.Pain Physician,2013,16(1):15~25.
[6]邱鹏程,潘略韬,刘剑芬,等.B超引导下脊神经根脉冲射频治疗颈部及上肢带状疱疹神经痛.实用医学杂志,2016,32(12):1999~2001.
[7]刘靖芷,史可梅,马文庭,等.CT三维重建引导下背根神经节脉冲射频治疗胸背部带状疱疹后神经痛的疗效.实用疼痛学杂志,2014,10(3):170~174.
[8]黄乔东,宫庆娟,薄存菊,等.DSA引导下背根节脉冲射频治疗带状疱疹后神经痛的疗效及安全性.实用医学杂志,2012,28(13):2187~2190.
[9]张广建,梁哲龙,李仁淑,等.背根节脉冲射频联合神经阻滞有效治疗带状疱疹后神经痛.中国疼痛医学杂志,2015,21(4):303~305.
[10]王文珠,王冉,刘建,等.背根神经节脉冲射频刺激联合普瑞巴林治疗带状疱疹后遗神经痛的临床疗效.临床麻醉学杂志,2014(7):663~665.
[11]金文哲,任婷婷,李仁淑,等.背根神经节脉冲射频联合连续硬膜外镇痛治疗老年带状疱疹后遗神经痛的临床观察.临床麻醉学杂志,2014,30(5):507~508.
[12]陆克银.背根神经节脉冲射频联合神经阻滞对带状疱疹后遗神经痛的疗效观察.贵阳医学院,2012.
[13]袁燕,申文,刘功俭,等.背根神经节脉冲射频联合药物治疗带状疱疹后神经痛的临床疗效分析.中国疼痛医学杂志,2012,18(8):473~475.
[14]郭文军,王哲银,梁庆华,等.脊神经背根带脉冲射频联合连续性硬膜外阻滞治疗带状疱疹后神经痛临床研究.中国伤残医学,2016,24(11):15~17.
[15]邓茹,刘庆.脊神经背根脉冲射频联合硬膜外神经阻滞治疗带状疱疹后神经痛的临床观察.医学信息,2016,29(9):47~48.
[16]张蓉,张妍,王秀莲,等.脉冲射频联合PECA治疗老年带状疱疹后神经痛的疗效和安全性.中国老年学,2016,36(6):1450~1452.
[17]黎飞,张娟娟,沈欢,等.脉冲射频联合得保松治疗带状疱疹后神经痛的疗效观察.安徽卫生职业技术学院学报,2013,12(4):43~44.
[18]张伟波.脉冲射频联合肋间神经阻滞治疗老年人胸背部带状疱疹后神经痛.浙江大学,2013.
[19]付强,郑宝森.脉冲射频治疗老年带状疱疹后神经痛的疗效及对血清肿瘤坏死因子-α和白细胞介素-1β水平的影响.中国老年学,2016(4):931~932.
[20]姚永玲.脉冲射频治疗三叉神经带状疱疹后神经痛的疗效观察.浙江临床医学,2012,14(2):168~169.
[21]王炅,吴英平.神经根脉冲射频治疗带状疱疹后遗神经痛的疗效.广东医学,2013,34(14):2218~2219.
[22]张彩琳,李亦梅.脉冲射频调节与神经阻滞治疗带状疱疹后神经痛的临床疗效观察.继续医学教育,2017,31(4):105~107.
[23]凌地洋,王哲银,卢振和,等.选择性背根神经节脉冲射频术联合普瑞巴林治疗带状疱疹后神经痛的临床观察.中国疼痛医学杂志,2013,19(10):587~591.
[24]犹云德,付德佳,余红亚.脉冲射频配合神经阻滞治疗带状疱疹后遗神经痛30例.实用心脑肺血管病杂志,2011,19(3):477~477.
[25]汪为刚,侯枫林.脉冲射频术治疗难治性胸段带状疱疹后遗神经痛疗效观察.按摩与康复医学,2014(3):121~122.
[26]Saxena AK,Lakshman K,Sharma T,et al.Modulation of serum BDNF levels in postherpetic neuralgia following pulsed radiofrequency of intercostal nerve and pregabalin.Pain Management,2016,6(3):217.
[27]黄宇光,徐建国.神经病理性疼痛临床诊疗学.2010.
[28]Johnson RW,Wasner G,Saddier P,et al.Postherpetic neuralgia:epidemiology,pathophysiology and management.Expert Review of Neurotherapeutics,2007,7(11):1581.
[29]赵志奇.带状疱疹痛:基础和临床概述.中国疼痛医学杂志,2014,20(6):369~375.
[30]于生元,万有,万琪,等.带状疱疹后神经痛诊疗中国专家共识.中国疼痛医学杂志,2016,22(3):161~167.