摘要
目的 探讨脊髓电刺激(SCS)治疗老年带状疱疹(HZ)对血清神经肽Y(NPY)、降钙素基因相关肽(CGRP)水平影响及后遗神经痛防范效果。方法 选取2021年3月至2023年6月我院老年HZ患者186例,随机数字表法分成高密度SCS(HD-SCS)组、标准密度SCS(SD-SCS)组及对照组,均62例。3组均口服伐昔洛韦、甲钴胺,对照组服用加巴喷丁控制疼痛,SD-SCS组采用常规SCS治疗;HD-SCS组采用高电脉冲密度SCS治疗。治疗2周后评估3组疗效。比较3组治疗前、治疗2周视觉模拟量表(VAS)评分、疼痛警觉与意识问卷(PVAQ)、匹兹堡睡眠质量指数(PSQI)评分、血清NPY、CGRP水平。随访6个月,统计电极程控调整频次、术后并发症或不良反应发生率、带状疱疹后遗神经痛(PHN)发生率。结果 HD-SCS组、SD-SCS组总有效率高于对照组(P<0.05);HD-SCS组、SD-SCS组总有效率对比,差异无统计学意义(P>0.05);HD-SCS组VAS、PSQI评分低于SD-SCS组、对照组,PVAQ评分低于SD-SCS组,SD-SCS组VAS、PSQI评分低于对照组(P<0.05);HD-SCS组NPY低于SD-SCS组、对照组,CGRP高于SD-SCS组、对照组(P<0.05),SD-SCS组NPY低于对照组,CGRP高于对照组(P<0.05);HD-SCS组电极程控调整频次少于SD-SCS组(P<0.05);治疗后3个月、治疗后6个月HD-SCS组PHN发生率低于对照组(P<0.05)。结论 SCS治疗老年HZ效果显著,可有效减轻患者疼痛,改善睡眠质量,调节血清NPY、CGRP水平,预防PHN,且高电脉冲密度SCS在降低患者对疼痛异感的关注、减少电极参数调整次数方面显示出一定优势,有助于提高患者对治疗的耐受性,更适用于老年患者。
Objective To investigate effects of spinal cord stimulation(SCS)on serum neuropeptide Y(NPY)and calcitonin gene related peptide(CGRP)in elderly patients with herpes zoster(HZ)and the preventive effect of neuralgia.Methods From March 2021 and June 2023,total 186 senior patients diagnosed with herpes zoster(HZ)at our hospital were selected as research objects.These patients were divided into three distinct groups using a random number table method:the high-density spinal cord stimulation(HD-SCS)group,the standard spinal cord stimulation(SD-SCS)group,and the control group,each comprised of 62 individuals.Three groups took Valaciclovir and mecobalamin orally,the control group took Gabapentin to control pain,and the SD-SCS group took conventional SCS treatment.The HD-SCS group received high density electrical pulses SCS treatment.The efficacy of three groups after 2 weeks of treatment were evaluated.The scores of visual analogue scale(VAS),pain vigilance and awareness questionnaire(PVAQ),Pittsburgh sleep quality index(PSQI),serum NPY and CGRP were compared before treatment and 2 weeks after treatment in three groups.Follow-up for 6 months,the number of electrode programmed parameter adjustments,the incidence of postoperative complications or adverse reactions,and the incidence of post-herpetic-neuralgia(PHN)were counted.Results Total effective rate in both the HD-SCS group and the SD-SCS group was significantly higher than that in control group(P<0.05).However,there was no statistically significant difference in the total effective rate between HD-SCS group and SD-SCS group(P>0.05).The VAS and PSQI scores of the participants in the HD-SCS group were noted to be significantly lower compared to both SD-SCS group and control group.Additionally,the PVAQ scores in the HD-SCS group were found to be lower than those observed in SD-SCS group.Furthermore,the VAS and PSQI scores in SD-SCS group were also reported to be lower than those recorded in control group(P<0.05).The NPY of HD-SCS group was lower than that of SD-SCS group and control group,and the CGRP was higher than that of SD-SCS group and control group(P<0.05).The NPY of SD-SCS group was lower than that of control group,and the CGRP was higher than that of control group(P<0.05).The number of electrode programmable parameter adjustments in HD-SCS group was less than that in SD-SCS group(P<0.05).The prevalence of PHN in HD-SCS group was observed to be reduced compared to control group both at the 3-month and 6-month follow-up assessments post-treatment(P<0.05).Conclusion SCS plays a crucial role in treating elderly patients suffering from HZ,as it is effective in reducing pain levels and enhancing the quality of sleep,regulate serum NPY and CGRP levels,prevent PHN.High density electrical pulses SCS has shown certain advantages in reducing patients attention to pain aversion and reducing the number of electrode parameter adjustments,and it helps improve patients tolerance to treatment and is more suitable for elderly patients.
作者
张雪
艾比不拉·依明
迪丽白尔·塔力甫江
菲尔东·阿布力孜
王德全
Zhang Xue;Aibibula Yiming;Dilibaier Talipujiang(Department of Pain,Xinjiang Uygur Autonomous Region People s Hospital,Urumqi,Xinjiang 830001,China)
出处
《四川医学》
2025年第5期514-520,共7页
Sichuan Medical Journal
基金
新疆维吾尔自治区卫生健康科技计划青年科研项目(编号:2025001QNKYXM653221483)。
