摘要目的:观察外周神经脉冲射频（PRF）联合重复经颅磁刺激（rTMS）治疗带状疱疹后神经痛（PHN）的疗效和安全性。方法:选取2021年4月至2023年1月武汉市第一医院收治的100例PHN患者，按照随机数字表法分为PRF组和联合组，每组50例。PRF组接受肌骨超声（MBU）引导下PRF（65V）治疗，联合组在PRF组的基础上进行rTMS（10 Hz）治疗。两组均治疗1个月，比较两组临床疗效、不良反应发生情况及治疗前（T0）、治疗后1周（T1）、1个月（T2）和3个月（T3）的视觉模拟评分表（VAS）、匹兹堡睡眠质量指数（PSOI）、生活质量量表（SF-36）和抑郁自评量表（SDS）评分。对两组T0、T1、T2、T3各项评价指标（VAS、PSOI、SF-36、SDS）采用双因素重复测量方差分析。结果:联合组总有效率明显高于PRF组（96.0%比86.0%， χ2＝11.520， P<0.05），联合组T1、T2、T3的VAS[（5.06±0.25）分比（6.15±0.22）分， F＝2.265， P<0.01；（2.26±0.32）分比（4.33±0.21）分， F＝1.034， P<0.01；（1.35±0.11）分比（2.61±0.08）分， F＝2.024， P<0.01]、PSOI[（10.55±0.78）分比（12.09±0.96）分， F＝1.411， P<0.01；（8.65±0.87）分比（9.98±0.56）分， F＝3.031， P<0.01；（7.56±0.22）分比（8.74±0.15）分， F＝6.888， P<0.01]、SDS[（43.76±4.52）分比（45.61±3.21）分， F＝2.783， P<0.01；（40.82±1.26）分比（41.95±0.53）分， F＝6.514， P<0.01；（28.21±0.42）分比（31.70±0.17）分， F＝2.468， P<0.01]评分均明显低于PRF组，而SF-36[（78.24±5.36）分比（75.66±1.25）分， F＝5.418， P<0.01；（80.23±1.02）分比（79.27±5.41）分， F＝2.177， P<0.01；（85.24±1.42）分比（81.23±1.24）分， F＝3.926， P<0.01]评分明显高于PRF组。 结论:MBU引导下外周神经PRF联合rTMS治疗PHN效果显著，可降低患者疼痛程度和抑郁程度并改善睡眠质量和生活质量，安全性高，优于单独使用PRF治疗。

abstractsObjective:To observe the efficacy and safety of peripheral nerve pulse radiofrequency (PRF) combined with repetitive transcranial magnetic stimulation (rTMS) in the treatment of long-term pain caused by postherpetic neuropain (PHN), and to provide a new idea and method for the treatment of PHN.Methods:From April 2021 to January2023, 100 patients with PHN were randomly divided into PRF group ( n=50) and combined group ( n=50). The PRF group was treated with PRF (65V) guided by muscle bone ultrasound (MBU), and the combined group was treated with rTMS (10 Hz) on the basis of PRF group. The clinical efficacy, adverse reactions and visual simulation scale (VAS), Pittsburgh sleep quality index (PSOI), quality of life scale (SF-36) and self-rating depression scale (SDS) before treatment (T0), 1 week after treatment (T1), 1 month after treatment (T2) and 3 months after treatment (T3) were compared between the two groups. The scores of VAS, PSOI, SF-36, SDS in both groups at T0, T1, T2, T3 were analyzed by double factor repeated measurement variance analysis. Results:The total effective rate of the combined group was significantly higher than that of the PRF group (96.0% vs. 86.0%, χ2=11.520, P<0.05). The scores of VAS (5.06±0.25 vs. 6.15±0.22, F=2.265, P<0.01; 2.26±0.32 vs. 4.33±0.21, F=1.034, P<0.01; 1.35±0.11 vs. 2.61±0.08, F=2.024, P<0.01), PSOI (10.55±0.78 vs. 12.09±0.96, F=1.411, P<0.01; 8.65±0.87 vs. 9.98±0.56, F=3.031, P<0.01; 7.56±0.22 vs. 8.74±0.15, F=6.888, P<0.01), and SDS (43.76±4.52 vs. 45.61±3.21, F=2.783, P<0.01; 40.82±1.26 vs. 41.95±0.53, F=6.514, P<0.01; 28.21±0.42 vs. 31.70±0.17, F=2.468, P<0.01) in the combined group were significantly lower than those in the control group, while the scores of SF-36 (78.24±5.36 vs. 75.66±1.25, F=5.418, P<0.01; 80.23±1.02 vs. 79.27±5.41, F=2.177, P<0.01; 85.24±1.42 vs. 81.23±1.24, F=3.926, P<0.01) were significantly higher than those in the control group. Conclusion:MBU guided peripheral nerve PRF combined with rTMS is effective in the treatment of PHN, which can reduce the degree of pain and depression, improve the quality of sleep and quality of life, and is safer than PRF alone.