《中国康复理论与实践》

《中国康复理论与实践》 ›› 2019, Vol. 25 ›› Issue (5): 579-585.doi: 10.3969/j.issn.1006-9771.2019.05.015

• 临床研究 • 上一篇    下一篇

不同频率高频重复经颅磁刺激治疗带状疱疹后神经痛的效果

裴倩1,2, 倪家骧2, 郭险峰1, 黄强1   

  1. 1.北京积水潭医院康复医学科，北京市 100035
    2.首都医科大学宣武医院疼痛科，北京市 100053
  • 收稿日期:2019-03-13 修回日期:2019-04-17 出版日期:2019-05-25 发布日期:2019-05-29
  • 通讯作者: 倪家骧(1957-)，男，汉族，辽宁绥中市人，主任医师、教授，博士生导师，主要研究方向：神经痛的微创介入治疗。E-mail: nijiaxiang@263.net
  • 作者简介:裴倩(1986-)，女，汉族，江苏徐州市人，博士，主治医师，主要研究方向：骨科康复、疼痛医学。
  • 基金资助:
    北京积水潭医院学科新星项目(No. XKXX201819)

Effects of Repetitive Transcranial Magnetic Stimulation in Different Frequencies on Post-herpetic Neuralgia

PEI Qian1,2, NI Jia-xiang2, GUO Xian-feng1, HUANG Qiang1   

  1. 1.Department of Rehabilitation Medicine, Beijing Jishuitan Hospital, Beijing 100035, China
    2.Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
  • Received:2019-03-13 Revised:2019-04-17 Published:2019-05-25 Online:2019-05-29
  • Contact: NI Jia-xiang, E-mail: nijiaxiang@263.net
  • Supported by:
    Beijing Jishuitan Hospital Nova Program (No. XKXX201819)

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摘要： 目的 观察不同频率高频重复经颅磁刺激(rTMS)治疗带状疱疹后神经痛的临床疗效和安全性。方法 2017年3月至2018年3月，60例带状疱疹后神经痛患者随机分成A组、B组和C组，各20例。A组接受假刺激，B组接受5 Hz rTMS，C组接受10 Hz rTMS，共10次(2周)。于治疗前(T0)、每次治疗后(T1~T10)、治疗结束后1个月(T11)、治疗结束后3个月(T12)，采用疼痛视觉模拟评分(VAS)、匹兹堡睡眠质量指数(PSQI)、患者总体印象变化量表(PGIC)评分、药物调节情况评分(MR)和不良事件发生率进行评定。结果 治疗后，与A组相比，T3~T12时B组和C组VAS评分降低(P < 0.05)，T7~T12时，C组VAS评分低于B组(P < 0.05)；B组平均VAS降低率低于C组(χ2 = 5.347, P < 0.05)；T12时，B组和C组PSQI和PGIC评分低于A组(P < 0.05)，C组评分低于B组(P < 0.05)。三组间MR和不良事件发生率无显著性差异(P > 0.05)。结论 5 Hz和10 Hz rTMS均能有效改善带状疱疹后神经痛患者疼痛并提高患者睡眠质量；10 Hz rTMS减轻疼痛、提高睡眠质量的疗效更优。

关键词: 带状疱疹后神经痛, 重复经颅磁刺激, 疼痛, 睡眠

Abstract: Objective To observe the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in frequencies of 5 Hz and 10 Hz for post-herpetic neuralgia (PHN).Methods From March, 2017 to March, 2018, 60 PHN patients were randomly divided into groups A (n = 20), B (n = 20) and C (n = 20), who accepted sham rTMS, 5 Hz rTMS and 10 Hz rTMS, respectively, ten times for two weeks. They were assessed with Visual Analogue Scale (VAS) of pain, Pittsburgh Sleep Quality Index (PSQI), Patients' Global Impression of Change Scale (PGIC), medication regulation (MR) and incidence of adverse events, before treatment (T0), immediately after stimulation (T1-T10), one month after treatment (T11) and three months after treatment (T12). Results Compared with group A, VAS scores reduced in groups B and C at T3-T12 (P < 0.05), and reduced more in group C than in group B at T7-T12 (P < 0.05). The average VAS reduction was less in group B than in group C (χ2 = 5.347, P < 0.05). The PSQI and PGIS scores were less in groups B and C than in group A at T12 (P < 0.05), while it was less in group C than in group B (P < 0.05). There was no significant difference among three groups in MR and the incidence of adverse events. Conclusions rTMS in either frequencies of 5 Hz or 10 Hz may relieve pain, and improve sleep for PHN patients, while 10 Hz rTMS seems more effective in terms of pain and sleep.

Key words: post-herpetic neuralgia, repetitive transcranial magnetic stimulation, pain, sleep

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