周围支脉冲射频联合阿霉素治疗三叉神经痛临床疗效观察

发布时间：2018-03-17 11:33

本文选题：三叉神经痛　切入点：阿霉素　出处：《承德医学院》2017年硕士论文　论文类型：学位论文

【摘要】：介入治疗是疼痛科较为主要的治疗方式之一,介入治疗整个过程是在影像设备的引导或监测下进行,具有相当高的准确性及安全性,能够准确地到达病变部位,且创伤相对微小,适应症广,并发症少等,三叉神经痛(trigeminal neuralgia TN)作为一种病理性神经痛,突然发作的尖锐疼痛,对患者的工作、生活造成的严重影响,而开放手术治疗三叉神经痛对于年老体弱或者不能承担手术风险的患者来说是难以奏效的。介入治疗创伤小,不需要麻醉或者仅需要局部麻醉即可完成,手术风险相对较小,易被接受。脉冲射频在疼痛的治疗中得到广泛的应用[1-2],它是对神经的“调理”而非毁损[3],相对温和,脉冲射频的优势有望成为三叉神经痛治疗的理想方式。然而,最近的报道指出脉冲射频对于治疗三叉神经痛虽然并发症较少,但是治疗的有效率是很低的。阿霉素介入治疗在近年来逐渐得到应用,阿霉素通过逆轴浆运输作用于半月神经节处选择性的毁损感觉神经,在去除疼痛的同时还保留触觉,面部麻木较少发生。但是阿霉素发挥作用需要作用时间,而作用时间内的疗效并不理想。需对研究利用阿霉素联合射频热凝进行TN的治疗,麻木情况发生较多,并没有显现出阿霉素自身的优势。而脉冲射频联合阿霉素治疗三叉神经痛并无相关研究。本研究旨在研究脉冲射频和阿霉素联合治疗三叉神经痛的有效率,为临床提供参考。目的:探讨周围支脉冲射频联合阿霉素治疗三叉神经痛的临床疗效及不良反应的发生情况。方法:住院治疗的90例原发性三叉神经痛经严格保守治疗无效的患者,将其随机分为三组(n=30),单纯阿霉素组(adriamycin ADM)、脉冲射频联合阿霉素组(Pulsed radiofrequency combine adriamycin PRF+ADM)以及单纯脉冲射频组(Pulsed radiofrequency PRF),比较三组患者术后1d、3d、7d、1月、3月、6月的VAS评分、PRI总分、睡眠时间、治疗有效率和并发症情况。结果:与治疗前比较,治疗后各时间点三组患者VAS评分、PRI(pain rating index)总分均明显降低、睡眠时间明显增多(P0.05);术后各时间点PRF+ADM组VAS评分、PRI总分明显低于PRF组,睡眠时间及治疗后有效率明显高于PRF组(P0.05);术后1d、3d PRF+ADM组VAS评分、PRI总分较ADM组差异有统计学意义(P0.05),其他各时间点两组各观察指标差异无统计学意义。三组均未出现明显并发症。结论:周围支脉冲射频联合阿霉素治疗三叉神经痛,在保留触觉仅破坏痛觉的同时止痛效果确切,可重复,相对安全,操作简便。
[Abstract]:Interventional therapy is one of the most important treatment methods in pain department. The whole process of interventional therapy is conducted under the guidance or monitoring of imaging equipment, which has high accuracy and safety, and can reach the lesion accurately. And the trauma is relatively small, the indication is wide, the complication is few and so on. Trigeminal neuralgia, as a kind of pathological neuralgia, sudden sharp pain, has a serious effect on the work and life of the patients. Open surgery for trigeminal neuralgia is difficult for patients who are old, frail or unable to bear the risk of surgery. Interventional therapy is less traumatic, requires no anesthesia or only requires local anesthesia, and the risk of surgery is relatively low. Pulse radiofrequency is widely used in the treatment of pain [1-2], it is the "conditioning" of the nerve, not damage [3], relatively mild, pulse radio frequency advantage is expected to become the ideal treatment of trigeminal neuralgia. Recent reports indicate that pulse radiofrequency has little complication in the treatment of trigeminal neuralgia, but the effective rate of treatment is very low. Adriamycin interventional therapy has been gradually applied in recent years. Adriamycin acts on the sensory nerve selectively in the meniscus ganglion through reverse axonal transport, while removing pain while retaining touch, facial numbness occurs less frequently. However, it takes time for Adriamycin to play its role. But the curative effect within the time of action is not ideal. It is necessary to study the use of adriamycin combined with radiofrequency thermocoagulation for the treatment of TN, and there are many cases of numbness. There was no evidence of the advantages of doxorubicin in the treatment of trigeminal neuralgia. This study was designed to investigate the efficacy of pulsed radio frequency combined with doxorubicin in the treatment of trigeminal neuralgia. Objective: to investigate the clinical efficacy and adverse reactions of peripheral branch pulse radio frequency combined with doxorubicin in the treatment of trigeminal neuralgia. Methods: 90 cases of primary trigeminal dysmenorrhea treated in hospital were treated with strict protection of trigeminal nerve dysmenorrhea. Patients who have failed treatment, The patients were randomly divided into three groups: adriamycin adriamycin adriamycin (adriamycin), pulsed radiofrequency combine adriamycin PRF adm (pulse radio frequency combined with adriamycin) and pulse radio frequency (RF) group. The VAS score and sleep time of the three groups were compared 1 day after operation and 3 days after operation. On January, March, June, the total VAS score and sleep time were compared between the three groups. Results: compared with before treatment, the VAS score and the total score of pri pain rating were significantly decreased in all three groups after treatment. The total VAS score of PRF ADM group was significantly lower than that of PRF group. The time of sleep and the effective rate after treatment were significantly higher than those in PRF group (P 0.05), the total score of VAS score in PRF ADM group was significantly higher than that in ADM group on the 1st day after operation, and there was no significant difference in other observation indexes between the two groups at other time points. Conclusion: peripheral branch pulse radio frequency combined with adriamycin in the treatment of trigeminal neuralgia, The analgesic effect is accurate, repeatable, relatively safe and easy to operate while preserving tactile sense only to destroy pain sense.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R745.11

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