超声引导下间断给药星状神经节阻滞术效果和并发症

目的 对比以不同方式行星状神经节阻滞术(SGB)对于疗效及并发症的影响。方法 对127例患者分别于超声引导下间断给药(A组，n=45)、超声引导下连续给药(B组，n=42)及解剖定位盲法穿刺给药(C组，n=40)后行首次SGB，比较组间首次穿刺成功率、SGB成功率、药物跨越警戒点(颈总动脉与颈内静脉交汇处)者占比、霍纳综合征出现和维持时间差异及短期并发症情况；以二分类logistic回归模型分析药物跨越警戒点与声音嘶哑的关系。结果 A、B组首次穿刺成功率及SGB成功率均高于C组(P均<0.05)。B组药物跨越警戒点者占比高于A组(P<0.05)。A、B组出现霍纳综合征时间均早于C组(P均<0.05)；A组霍纳综合征维持时间最长，B组次之，C组最短，两两比较差异均有统计学意义(P均<0.05)。术后A组2例、B组8例、 C组12例声音嘶哑，B、C组声音嘶哑发生率明显高于A组(P均<0.05)；A组2例、B组2例、C组7例穿刺点疼痛；C组4例食管损伤，其穿刺点疼痛及食管损伤发生率均高于A、B组(P均<0.05)。结论 超声引导下间断给药法SGB较超声引导下连续给药及解剖定位盲法穿刺给药成功率高，维持时间长且并发症少。

Therapeutic effect and complications of stellate ganglion block with ultrasound-guided intermittent drug administration

Objective To compare the effects and complications of stellate ganglion block (SGB) with different guidance and administration methods. Methods The first time SGB were performed in 127 patients, including ultrasound-guided intermittent administration in 45 cases (group A), ultrasound-guided continuous administration in 42 cases (group B) and anatomic location blind puncture administration in 40 cases (group C). The success rate of the first puncture and SGB, the ratio of drugs crossing the warning point (intersection of common carotid artery and internal jugular vein), the appearance and maintenance time of Horner syndrome, and the occurrence of short-term complications were compared among groups. Binary logistic regression model was used to analyze the relationship between drug crossing the warning point and hoarseness. Results The success rate of the first puncture and SGB in group A and B were higher than those in group C (both P<0.05). The ratio of drug crossing the warning point in group B was higher than that in group A (P<0.05). The appearance of Horner syndrome in group A and B were earlier than that in group C (both P<0.05). The maintenance time of Horner syndrome was the longest in group A, followed by group B and group C, and there were significant differences between each two groups (all P<0.05). Hoarseness occurred in 2 cases in group A, 8 cases in group B and 12 cases in group C, and the incidence of hoarseness in group A was significantly lower than that in group B and C (both P<0.05). Pain at the puncture point was complained in 2 cases in group A, 2 cases in group B and 7 cases in group C. Esophageal injury occurred only in 4 cases of group C. The incidences of puncture pain and esophageal injury in group C were higher than those in group A and B (all P<0.05). Conclusion Ultrasound-guided intermittent administration of SGB had higher success rate, longer maintenance time and fewer complications both than ultrasound-guided continuous and anatomic location blind puncture administration.