阅读说明：本技术 一种治疗带状疱疹神经痛的低温等离子周围神经调理方法 (Low-temperature plasma peripheral nerve conditioning method for treating herpes zoster neuralgia ) 是由 孙岩军 卞菊花 奚诚玺 周昊 高照 殷锦霞 于 2019-10-11 设计创作，主要内容包括：一种治疗带状疱疹神经痛的低温等离子周围神经调理方法,本发明涉及医疗技术领域,采用皮下局部浸润麻醉进行局部浸润麻醉后,以12号穿刺针15°进针,抵达皮下,连接等离子刀头,连接等离子射频机,调节射频机消融强度在3档,每点消融时间是电切5秒,电凝5秒,消融同时左右摆动针尾,以增大消融范围,每0.5cm为一个消融点,边退针边消融,直到将疼痛部位全部消融为止,消融结束,局部敷料贴敷,手术部位保持清洁干燥48h。治疗的靶点在末梢神经,通过对末梢神经的刺激调理,达到抑制末梢神经元异常放电的目的,从而控制疼痛,其疗效可靠,操作简单安全,有较高的临床实用价值。(A low-temperature plasma peripheral nerve conditioning method for treating herpes zoster neuralgia relates to the technical field of medical treatment, and is characterized in that after local infiltration anesthesia is carried out by adopting subcutaneous local infiltration anesthesia, a needle is inserted by 15 degrees through a No. 12 puncture needle, the needle reaches the subcutaneous part, a plasma cutter head is connected, a plasma radio frequency machine is connected, the ablation intensity of the radio frequency machine is adjusted to be 3 grades, the ablation time at each point is 5 seconds of electrotomy and 5 seconds of electrocoagulation, the needle tail is swung left and right during ablation so as to enlarge the ablation range, each 0.5cm is an ablation point, the needle is withdrawn while ablation is carried out until the pain part is completely ablated, ablation is finished, local dressing is pasted, and the operation part is kept clean and dry for 48 hours. The target point of treatment is peripheral nerve, and the aim of inhibiting abnormal discharge of peripheral nerve cells is fulfilled by stimulating and conditioning the peripheral nerve, so that pain is controlled, the curative effect is reliable, the operation is simple and safe, and the clinical practical value is higher.)

1. A low-temperature plasma peripheral nerve conditioning method for treating herpes zoster neuralgia is characterized by comprising the following steps: the operation steps are as follows:

(1) local anesthetic blending: 20ml of 2% lidocaine and 20ml of 0.9% normal saline are prepared into 1% local anesthetic without adrenalin;

(2) after the patient enters an operating room, the vein access is opened conventionally, the electrocardiographic monitoring is carried out, a proper operation position is selected according to the pain position, the pain position is fully exposed, and a piece of cloth is spread for local conventional disinfection;

(3) puncturing and treating: after the subcutaneous local infiltration anesthesia is adopted for local infiltration anesthesia, pain immediately disappears at the moment, a needle is inserted by a No. 12 puncture needle at 15 degrees, the needle reaches the subcutaneous part, a plasma cutter head is connected, a plasma radio frequency machine is connected, the ablation intensity of the radio frequency machine is adjusted to be 3 grades, the ablation time at each point is 5 seconds of electrotomy, 5 seconds of electrocoagulation are carried out, the needle tail is swung left and right during ablation so as to enlarge the ablation range, each 0.5cm is an ablation point, the needle is withdrawn while ablation is carried out until the pain part is completely ablated, the ablation is finished, the local dressing is applied, and the operation part is kept clean and dry for 48 hours.

2. The method of low temperature plasma peripheral nerve conditioning for the treatment of postherpetic neuralgia according to claim 1, wherein: the times of puncture and treatment are determined according to the area of the pain part of the patient, a certain area is treated every time, and the treatment can be carried out once a day or every other day according to the condition of the patient until the pain part of the patient is completely covered.

3. The method of low temperature plasma peripheral nerve conditioning for the treatment of postherpetic neuralgia according to claim 1, wherein: before the patient in the step (1) enters an operating room, the patient needs to be checked for blood pressure, blood sugar, fibrinolytic function, electrocardiogram, chest radiography and the like; treating patients with hypertension, diabetes, coronary heart disease, etc. before operation, and adjusting to basic normal level; before operation, the patient communicates with family members and patients, the treatment method, the operation process, the expected effect and possible complications after the operation are dealt with in detail, and an operation informed consent is signed.

Technical Field

The invention relates to the technical field of medical treatment, in particular to a low-temperature plasma peripheral nerve conditioning method for treating herpes zoster neuralgia.

Background

Shingles is a skin disorder caused by the reactivation of varicella-zoster virus which is latent in sensory ganglia and causes inflammation of the skin in the area innervated by the sensory nerve, manifested as skin blisters appearing in clusters along the corresponding segments of the sensory nerve, often with significant pain. After the acute phase, the herpes scabs fall off and the skin lesion heals, but some patients leave or reappear severe persistent or episodic pain known as postherpetic neuralgia (PHN). Most of the neuropathic pain of herpes zoster is severe in pain, often accompanied by hyperalgesia or allodynia, and seriously affects the quality of life of patients.

The mechanism of neuropathic pain caused by herpes zoster is very complex and has not been fully elucidated so far, but its central and peripheral mechanisms have been basically recognized by scholars. The central mechanism comprises central sensitization, central disinhibition, A beta fiber sprouting, activation of a descending facilitation system, activation of glial cells and the like. Central sensitization refers to the increased excitability of spinal neurons resulting from long-term inflammation and nerve damage. Nerve injury causes excitatory amino acid release, NMDA and non-NMDA receptors are activated, the synaptic frequency of neurons is increased, spontaneous and induced neuron discharge is increased, and the sensibility is expanded, and the plasticity change of the neurons can form the basis of neuropathic pain. Central disinhibition is mainly accomplished by the descending pathway of the brainstem and the interneurons of the spinal cord through inhibitory neurotransmitters such as glycine, 5-hydroxytryptamine, GABA, enkephalin, etc. After nerve injury, inhibitory interneurons are partially destroyed and the inhibitory effect is diminished. It was found that the Dorsal Root Ganglion (DRG) sympathetic axon of the rat model of neuropathic pain germinated, and the primary afferent myelinating low-threshold A β nerve fibers formed new synapses with C fibers, activating spinal dorsal horn neurons that were otherwise unresponsive to stimulation of C fibers, causing increased sensitivity of spinal sensory neurons to cold, heat, and mechanical stimulation. The descending facilitation system comprises the periaqueductal gray matter (PAG), anterior cingulate gyrus, hypothalamus, amygdala, ventral medial nucleus (RVM) of the brain, solitary bundle nucleus and dorsal reticular nucleusAnd the like. Studies have shown that the descending facilitation system enhances the body's ability to respond to noxious stimuli by lowering the pain threshold, which is involved in the development of hyperalgesia and central sensitization. Following nerve injury, the descending facilitation system is activated and the pain threshold is reduced, i.e. hyperalgesia or allodynia occurs. In recent years, there has been a great deal of experimental evidence that glial cells play a very important role not only in the support, protection and nutrition of the central nervous system, but also in the generation and maintenance of pain sensation. Nerve damage can activate glial cells, mainly astrocytes and microglia. The activated glial cells produce and release a large amount of excitatory neurotransmitters such as cytokines and inflammatory mediators, and the accumulation of the large amount of neurotransmitters can sensitize neurons and glial cells, so that the pathological neuralgia is further developed. The peripheral mechanism of neuropathic pain is primarily peripheral sensitization, which is mainly manifested by ectopic discharge of damaged peripheral afferent fibers and increased excitability of adjacent undamaged nerve fibers. Studies have shown that demyelination and abnormal regeneration can occur following peripheral nerve injury, resulting in the formation of neuroma, which spontaneously discharges without stimulation, and which discharges with increased frequency and intense pain caused by chemical or mechanical stimulation. The mechanism of spontaneous discharge of neuroma is not clear so far, and most scholars consider it to be associated with voltage-gated Na + channels and voltage-dependent K on sensory neurons⁺、Ca²⁺The channel changes. It has been shown that not only the injured sensory neurons produce ectopic impulses after nerve injury, but also their neighboring uninjured neurons become more excitable.

The low-temperature plasma radio frequency ablation is an operation mode of minimally invasive interventional therapy and is a new electrochemical-based technology developed in recent years. The bipolar radio frequency is used for generating energy, electrolyte between a tissue and a radio frequency cutter head is converted into a plasma thin layer, charged particles in the plasma are accelerated by an electric field and then transfer the energy to the tissue, molecular bonds forming cell components in a target tissue are dissociated, the tissue is decomposed into small molecular gas, and the purpose of tissue volume reduction is achieved. Since this effect is localized to the surface layer of the target tissue and is at a relatively low temperature (40 ℃ C. -70 ℃ C.), thermal damage to surrounding tissue is minimized. Research shows that nerve fibers conducting pain sensation are degenerated at the temperature of more than 70 ℃ for 120s, so that low-temperature plasma cannot cause degeneration of sensory nerve tissues, and only heat effect stimulates and conditions nerves, so that abnormal discharge of the nerves is conditioned to normal discharge, the aim of treating pain is fulfilled, and side effects such as sensory deterioration or nerve injury after operation are avoided to the greatest extent.

The current methods for treating post-herpes zoster pain are broadly divided into the following: first-line drugs are anticonvulsants, 5-hydroxytryptamine norepinephrine reuptake inhibitors and tricyclic antidepressants, which are currently recommended by research; the second-line medicine is 8% capsaicin patch, 5% lidocaine patch and tramadol; the third-line drugs are botulinum toxin type A and strong opioids. ② selective regional nerve therapy, mainly including nerve block therapy (local anesthetic intradermal injection or peripheral nerve trunk, plexus block to block pain sensation from conducting to the central, stellate ganglion block, epidural block, paravertebral nerve block, nerve trunk and branch block can be selected according to different pain parts), nerve regulation operation (including percutaneous nerve electric stimulation, peripheral nerve stimulation, deep brain stimulation, spinal cord electric stimulation, percutaneous spinal cord electric stimulation and motor cortex stimulation) and nerve destruction operation (peripheral nerve destruction operation, spinal nerve posterior root destruction operation, semilunar ganglion destruction operation, etc.). Other treatments, including psychotherapy and physical therapy (ultrasound, phototherapy, electrotherapy, cold spray, etc.). All of the above treatments are effective, but some patients still have pain that is not relieved after various treatments.

Disclosure of Invention

The invention aims to provide a low-temperature plasma peripheral nerve conditioning method for treating herpes zoster neuralgia, which is reasonably designed, aims at overcoming the defects and defects of the prior art, achieves the aim of inhibiting abnormal discharge of peripheral neurons by conditioning peripheral nerves and conditioning the peripheral nerves by stimulating the peripheral nerves due to the fact that the herpes zoster is treated by plasma, and has reliable curative effect, simple and safe operation and higher clinical practical value.

In order to achieve the purpose, the invention adopts the following technical scheme: the operation steps are as follows:

1. local anesthetic blending: 20ml of 2% lidocaine and 20ml of 0.9% normal saline are prepared into 1% local anesthetic without adrenalin;

2. after a patient enters an operating room, the vein access is opened conventionally, the electrocardiographic monitoring is carried out, a proper operation position is selected according to a pain position, the pain position is fully exposed, and a piece of cloth is spread for local conventional disinfection;

3. puncturing and treating: after the subcutaneous local infiltration anesthesia is adopted for local infiltration anesthesia, pain immediately disappears at the moment, a needle is inserted by a No. 12 puncture needle at 15 degrees, the needle reaches the subcutaneous part, a plasma cutter head is connected, a plasma radio frequency machine is connected, the ablation intensity of the radio frequency machine is adjusted to be 3 grades, the ablation time at each point is 5 seconds of electrotomy, 5 seconds of electrocoagulation are carried out, the needle tail is swung left and right during ablation so as to enlarge the ablation range, each 0.5cm is an ablation point, the needle is withdrawn while ablation is carried out until the pain part is completely ablated, the ablation is finished, the local dressing is applied, and the operation part is kept clean and dry for 48 hours.

Furthermore, the times of puncture and treatment are determined according to the area of the pain part of the patient, a certain area is treated every time, and the treatment can be carried out once a day or every other day according to the condition of the patient until the pain part of the patient is completely covered.

Further, before the patient in the step 1 enters an operating room, the patient needs to be checked for blood pressure, blood sugar, fibrinolytic function, electrocardiogram, chest radiography and the like in a routine way; treating patients with hypertension, diabetes, coronary heart disease, etc. before operation, and adjusting to basic normal level; before operation, the patient communicates with family members and patients, and the treatment method, the operation process, the expected effect and possible complications after the operation, such as infection and the like, are handed in detail, and an informed consent of the operation is signed.

After adopting the structure, the invention has the beneficial effects that: the invention provides a low-temperature plasma peripheral nerve conditioning method for treating herpes zoster neuralgia, and the plasma treatment of herpes zoster is carried out through peripheral nerve conditioning treatment, the target point of the treatment is peripheral nerve, and the aim of inhibiting abnormal discharge of peripheral nerve cells is fulfilled through stimulation conditioning of the peripheral nerve, so that pain is controlled, the curative effect is reliable, the operation is simple and safe, and the low-temperature plasma peripheral nerve conditioning method has higher clinical practical value.

Description of the drawings:

fig. 1 is a statistical table of the therapeutic effects of the examples.

The specific implementation mode is as follows:

the technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the drawings in the embodiments of the present invention, and it is obvious that the described embodiments are only a part of the embodiments of the present invention, and not all of the embodiments. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.

The specific implementation mode adopts the following technical scheme: the operation steps are as follows:

1. preoperative preparation: before a patient enters an operating room, the patient needs to routinely check blood pressure, blood sugar, fibrinolytic function, electrocardiogram, chest radiography and the like; treating patients with hypertension, diabetes, coronary heart disease, etc. before operation, and adjusting to basic normal level; before operation, communicating with family members and patients, giving detailed treatment methods, operation processes, expected effects and possible complications after operation, such as infection and the like, and signing an operation informed consent;

2. local anesthetic blending: 20ml of 2% lidocaine and 20ml of 0.9% normal saline are prepared into 1% local anesthetic without adrenalin;

3. after a patient enters an operating room, the vein access is opened conventionally, the electrocardiographic monitoring is carried out, a proper operation position is selected according to a pain position, the pain position is fully exposed, and a piece of cloth is spread for local conventional disinfection;

4. puncturing and treating: after the subcutaneous local infiltration anesthesia is adopted for local infiltration anesthesia, pain immediately disappears at the moment, a needle is inserted by a No. 12 puncture needle at an angle of 15 degrees, the needle reaches the subcutaneous part, a plasma cutter head is connected, a plasma radio frequency machine is connected, the ablation intensity of the radio frequency machine is adjusted to be 3 grades, the ablation time at each point is 5 seconds of electrotomy, 5 seconds of electrocoagulation, the needle tail is swung left and right during ablation to enlarge the ablation range, the ablation point is one ablation point every 0.5cm, the needle is retreated and the ablation is carried out simultaneously until the pain part is completely ablated, the ablation is finished, the local dressing is applied, the operation part is kept clean and dry for 48h, the puncture and treatment times are determined according to the area of the pain part of a patient, a certain area is treated every time, the treatment can be carried out once every day or every other.

The beneficial effects of the embodiment are as follows: the specific embodiment provides a low-temperature plasma peripheral nerve conditioning method for treating herpes zoster neuralgia, and the plasma treatment of herpes zoster is carried out through peripheral nerve conditioning treatment, the target point of the treatment is peripheral nerve, and the abnormal discharge of peripheral nerve cells is inhibited through stimulation conditioning of the peripheral nerve, so that pain is controlled, the curative effect is reliable, the operation is simple and safe, and the clinical practical value is higher.