国际麻醉学与复苏杂志   2018, Issue (9): 0-0
    
红外热成像及抑郁量表用于评价带状疱疹后神经痛治疗效果的作用分析
高雅, 王秋石1()
1.中国医科大学附属第一医院
Evaluation of therapeutic efficacy of radiotherapy for the treatments of herpes zoster neuralgia with infrared thermography and depression scale
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摘要:

目的 观察高电压长时程双极脉冲射频治疗对带状疱疹后神经痛(postherpetic neuralgia, PHN)患者病变区域皮肤红外热成像图的影响并分析疗效差异性与情绪的关系。 方法 收集30例病程2~4个月躯干部位带状疱疹患者,记录患者一般资料。术前评估患者VAS评分、汉密尔顿抑郁量表17项(Hamilton Depression Scale-17, HAMD-17)评分,摄病变部位皮肤的红外热成像图,并分析病变部位与正常部位皮肤的温度差。治疗均在CT引导下进行,完成标准的600 s高电压长时程双极脉冲射频,术中治疗参数保持一致(频率3 Hz,脉宽30 ms,电压50~70 V)。记录患者术后1、3、7、14 d VAS评分,记录术后1、3 d红外热成像图,记录术后7、14 d HAMD-17评分。 结果 患者术后1、3 d VAS评分与术前相比明显下降,差异有统计学意义(P<0.05)。术后7、14 d VAS评分有所上升,与术前评分差异无统计学意义(P>0.05)。患者红外热像图术前病变部位相对于健侧温度平均升高(0.53±0.28) ℃,术后1 d双侧温差变为(0.27±0.22) ℃,与术前比较差异有统计学意义(P<0.05);术后3 d双侧温差为(0.28±0.24) ℃,与术前比差异有统计学意义(P<0.05)。患者HAMD-17评分,其中24例术前评分>17分并且术后未明显改变。术前患者VAS评分与HAMD-17评分间有一定的相关性(P=0.006,r=0.492);而术后,对于VAS评分上升的患者,其与HAMD-17的相关性较强(P=0.023,r=0.872)。 结论 高电压长时程双极脉冲射频治疗后带状疱疹病变区域与正常部位皮肤红外热成像图温度差缩小。治疗1周后疗效欠佳患者与其并存的抑郁情绪密切相关。

关键词: 红外热成像; 双极脉冲射频; 神经痛,带状疱疹后; 抑郁
Abstract:

Objective To evaluate the therapeutic effect of high-voltage long-duration bipolar pulsed radiofrequency (PRF) radiotherapy on postherpetic neuralgia (PHN) by measuring temperature shift on abnormal skin with infrared thermography and examining mood improvement with depression scale. Methods Thirty patients suffered from herpes zoster on the torso for 2-4 months were enrolled in this study. Demographic data of these patients were collected. Preoperative pain symptoms and mood status were respectively assessed with VAS and Hamilton Depression Scale-17 (HAMD-17). Infrared thermograph of the lesioned skins were taken and the temperature differences between the lesioned and the normal skins were analyzed. The standard 600 s high-voltage (50-70 V) long-duration (30 ms) bipolar pulsed radiofrequency (3 Hz) radiotherapy was performed under the guidance of CT. The VAS scores, thermographs and HAMD-17 scores were recorded after radiotherapy. Results In a total of 30 patients, the VAS were significantly reduced 1 and 3 days after radiotherapy (P<0.05). The VAS were increased to the preoperative levels 7 and 14 days after radiotherapy (P>0.05). The infrared thermography showed that the temperature was (0.53±0.28) °C higher in lesioned area than in healthy area, but the difference was significantly reduced 1 and 3 days after radiotherapy[1 day: (0.27±0.22) °C, 3 days: (0.28±0.24) °C]. Preoperative HAMD-17 scores in 24 out of 30 patients were greater than 17 and did not change after operation. Interestingly, there was a significant correlation between VAS and HAMD-17 scores before (P=0.006, r=0.492) and after operation (P=0.023, r=0.872). Conclusions After 1 and 3 days treatment, high-voltage long-duration bipolar pulsed radiofrequency radiography relieved pain symptoms, reduced temperature in abnormal skin, but did not improve moods, in patients suffered from postherpetic neuralgia.

Key words: Thermal imaging; Bipolar pulsed radiofrequency treatment; Neuralgia, postherpetic; Depression