本文選題：三叉神經(jīng)痛　切入點：阿霉素　出處：《承德醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：介入治療是疼痛科較為主要的治療方式之一,介入治療整個過程是在影像設(shè)備的引導(dǎo)或監(jiān)測下進行,具有相當高的準確性及安全性,能夠準確地到達病變部位,且創(chuàng)傷相對微小,適應(yīng)癥廣,并發(fā)癥少等,三叉神經(jīng)痛(trigeminal neuralgia TN)作為一種病理性神經(jīng)痛,突然發(fā)作的尖銳疼痛,對患者的工作、生活造成的嚴重影響,而開放手術(shù)治療三叉神經(jīng)痛對于年老體弱或者不能承擔手術(shù)風(fēng)險的患者來說是難以奏效的。介入治療創(chuàng)傷小,不需要麻醉或者僅需要局部麻醉即可完成,手術(shù)風(fēng)險相對較小,易被接受。脈沖射頻在疼痛的治療中得到廣泛的應(yīng)用[1-2],它是對神經(jīng)的“調(diào)理”而非毀損[3],相對溫和,脈沖射頻的優(yōu)勢有望成為三叉神經(jīng)痛治療的理想方式。然而,最近的報道指出脈沖射頻對于治療三叉神經(jīng)痛雖然并發(fā)癥較少,但是治療的有效率是很低的。阿霉素介入治療在近年來逐漸得到應(yīng)用,阿霉素通過逆軸漿運輸作用于半月神經(jīng)節(jié)處選擇性的毀損感覺神經(jīng),在去除疼痛的同時還保留觸覺,面部麻木較少發(fā)生。但是阿霉素發(fā)揮作用需要作用時間,而作用時間內(nèi)的療效并不理想。需對研究利用阿霉素聯(lián)合射頻熱凝進行TN的治療,麻木情況發(fā)生較多,并沒有顯現(xiàn)出阿霉素自身的優(yōu)勢。而脈沖射頻聯(lián)合阿霉素治療三叉神經(jīng)痛并無相關(guān)研究。本研究旨在研究脈沖射頻和阿霉素聯(lián)合治療三叉神經(jīng)痛的有效率,為臨床提供參考。目的:探討周圍支脈沖射頻聯(lián)合阿霉素治療三叉神經(jīng)痛的臨床療效及不良反應(yīng)的發(fā)生情況。方法:住院治療的90例原發(fā)性三叉神經(jīng)痛經(jīng)嚴格保守治療無效的患者,將其隨機分為三組(n=30),單純阿霉素組(adriamycin ADM)、脈沖射頻聯(lián)合阿霉素組(Pulsed radiofrequency combine adriamycin PRF+ADM)以及單純脈沖射頻組(Pulsed radiofrequency PRF),比較三組患者術(shù)后1d、3d、7d、1月、3月、6月的VAS評分、PRI總分、睡眠時間、治療有效率和并發(fā)癥情況。結(jié)果:與治療前比較,治療后各時間點三組患者VAS評分、PRI(pain rating index)總分均明顯降低、睡眠時間明顯增多(P0.05);術(shù)后各時間點PRF+ADM組VAS評分、PRI總分明顯低于PRF組,睡眠時間及治療后有效率明顯高于PRF組(P0.05);術(shù)后1d、3d PRF+ADM組VAS評分、PRI總分較ADM組差異有統(tǒng)計學(xué)意義(P0.05),其他各時間點兩組各觀察指標差異無統(tǒng)計學(xué)意義。三組均未出現(xiàn)明顯并發(fā)癥。結(jié)論:周圍支脈沖射頻聯(lián)合阿霉素治療三叉神經(jīng)痛,在保留觸覺僅破壞痛覺的同時止痛效果確切,可重復(fù),相對安全,操作簡便。
[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.
【學(xué)位授予單位】：承德醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R745.11

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