额神经阻滞

过去阻滞眶上神经和滑车抻经或只阻滞眶上神经或滑车神经的方法称额抻经阻滞。最近开始，阻滞针刺入一处就能同时阻滞眶上神经和滑车上神经称额神经阻滞(frontal nerve block)。对带状疱疹后神经痛使用局部麻醉药，对原发性三叉抻经痛、癌性疼痛一般使用神经破坏药。     

急性脑外伤合并视神经损伤手术治疗11例分析

目的探讨颅脑损伤合并视神经损伤的有效治疗方法。方法手术治疗 11例颅脑损伤合并视神经损伤患者 ,9例行额部冠状切开头皮 ,一侧额部开颅清除眶骨骨折片或出血 ,矫正额眶骨折错位畸形。有视神经管骨折者 ,用微钻磨开视神经管 ,剪开视神经鞘进行神经减压。 2例眶尖综合征者行额颞切口 ,经眶尖外侧壁磨开眶上裂和视神经管神经减压。结果 8例有效 ,其中 2例眼球突出、1例眼球内陷均得到矫正。结论经额部或额颞入路手术行视神经减压 ,对颅脑损伤合并视神经损伤的患者可取得良好效果     

外科治疗颅底骨折并视神经损伤18例

目的:探讨颅底骨折并视神经损伤的外科治疗方法.方法:总结18例经手术治疗的颅底骨折并视神经损伤的患者资料,其中10例行额部冠状切开减压,5例行额颞部开颅清除眶骨骨折片或血肿,矫正额眶骨折错位畸形;时存在视神经管骨折者,用微钻磨开视神经管,切开视神经鞘进行减压.3例眶尖综合征者行额颞切口,经眶尖外侧壁磨开眶上裂和视神经管减压.随访6个月以上,分析临床治疗效果.结果:本组手术治疗18例,其中显效8例,占44.4%;有效7例,占38.9%;无效3例,占16.7%.结论:颅底骨折并视神经损伤外科治疗的疗效与视神经损伤程度和手术时间等因素有关;外伤后早期经额部或额颞入路手术行视神经减压,结合术后高压氧治疗对颅脑损伤合并视神经损伤的患者可取得良好效果.     

球后肿瘤手术及入路选择的应用研究

目的 :对球后肿瘤手术入路进行选择 ,改良额眶入路。方法 :对 8例经额颞眶顶外侧入路治疗球后肿瘤的病例进行分析。结果 :8例球后肿瘤均经该入路直视下肿瘤全切 ,视力 :3例恢复正常 ,3例好转 ,2例未恢复。结论 :颅眶区解剖复杂 ,手术宜在显微直视下进行 ;球后大多数肿瘤可首选额颞眶外侧入路。     

神经阻滞术治疗带状疱疹58例体会

笔者采用神经阻滞术治疗带状疱疹 58例 ,现将结果报告如下。1　临床资料本组 58例中 ,男 2 6例 ,女 32例 ,年龄 32～84岁。疱疹伴神经痛者 1 8例 ,疱疹愈合留有顽固性神经痛 30例。病毒侵犯三叉神经Ⅰ支 3例 ,颈神经 2例 ,胸神经 52例 ,腰神经 1例。病程 1～ 1 4周 ,疗程 6～ 52ｄ。神经阻滞药物配方 :病毒唑 维生素Ｂ1 2 布比卡因混合液共 8～ 40ｍｌ。三叉神经Ⅰ支神经痛选择三叉神经根区注射 眶上神经阻滞 ,臂丛神经痛选臂丛阻滞 ,胸部神经痛选择胸椎旁阻滞 ,4例带状疱疹后遗神经痛者 ,1例治愈 ,3例疼痛程度减轻 ;其余 54例均治愈。总…     

射频温控热凝术治疗带状疱疹后遗三叉神经痛的临床疗效

[目的]探讨射频温控热凝术治疗带状疱疹后遗三叉神经痛的临床疗效及并发症.[方法]对头面部带状疱疹后遗三叉神经痛的6例患者采用射频针经皮穿刺找到眶上神经及滑车上神经,给标准射频600、60s,700、60s,800、120s（两同期）治疗,同时注射消炎镇痛液.[结果]5例患者痊愈,1例患者好转.[结论]带状疱疹后遗神经痛缺乏确切有效的治疗方法,采用射频温控热凝术＋神经阻滞治疗疱疹后三叉神经痛可以取得很好的疗效.     

神经阻滞治疗带状疱疹神经痛临床疗效观察

目的 探讨神经阻滞在治疗带状疱疹神经痛及带状疱疹后神经痛(PNH)中的临床疗效.方法 总结我院麻醉科疼痛病房2003年3月至2007年10月所收治的167例带状疱疹神经痛及PNH患者,比较单纯药物治疗与合用神经阻滞治疗后疼痛缓解程度(VAS评分),自觉疼痛缓解程度评分、睡眠受影响率、并发症发生情况.结果 167例患者中,带状疱疹神经痛组(85例)中,单纯药物治疗后,VAS评分降低(1.61±1.8)分,72%患者仍存在中～重度疼痛;合用神经阻滞治疗后,VAS评分降低(4.14±2.17)分,63%患者睡眠改善.PNH组(82例)中,单纯药物治疗后,VAS评分降低(1.21±0.96)分,85%患者仍存在中～重度疼痛;合用神经阻滞治疗后,VAS评分降低(4.21±1.77)分,55%患者睡眠改善.结论 神经阻滞治疗对带状疱疹神经痛及PNH均有疗效.     

经额颞眶颧入路视神经管减压术

目的:探讨额颞眶颧视神经管减压术的手术方法及治疗意义。方法:采用经额颞眶颧视神经管减压术治疗15例外伤性视神经损伤患者。结果:8例患者术后视力较术前提高>0.1;4例患者有改善<0.1;3例无好转。结论:经额颞眶颧视神经管减压术是一种治疗外伤性视神经损伤有效的手段。     

腰丛神经阻滞对肿瘤转移性神经痛的疗效观察

目的观察腰丛神经阻滞对肿瘤转移性神经痛的镇痛效果。方法选择12例患有腹部/盆腔肿瘤并伴有转移性神经痛的患者,接受腰丛神经阻滞治疗。观察治疗前后患者的疼痛程度、阿片药物需求量及副作用发生率。结果接受腰丛神经阻滞治疗后,患者的VAS疼痛评分显著降低(P0.05),阿片药物使用量及相关副作用显著减少(P0.05)。结论腰丛神经阻滞能够有效降低肿瘤转移性神经痛的疼痛程度,减少阿片类药物需求量及其副作用。     

中频电穴位治疗原发性眶神经痛46例

眶神经痛 4 6例均为门诊患者 ,男 2 7例 ,女19例 ;年龄 17～ 6 5岁 ,平均 38岁 ;病程 3ｈ～ 50ｄ ,平均 2 3ｄ ;眶上神经痛 34例 ,眶下神经痛 12例 ;疼痛位于右眼 2 5例 ,左眼 2 1例 ;患者初期表现为颜面稍感不适 ,继而上或下眼眶内深部疼痛 ,多偏内侧 ,指压眶内深部则疼痛剧烈 ,伴偏头痛 ,一般 9～ 12时和 14～17时发作 ,严重时伴恶心呕吐。 35例经药物、封闭及针灸治疗后复发。对照组 38例为同期门诊患者 ,其性别、年龄、疼痛性质及程度与中频电穴位治疗组无显著差异。两组患者均经眼科与神经内科确诊。　　治疗组采用北京产Ｋ8832 -Ｔ电…     

Supraorbital neuralgia: a clinical study

A series of 18 patients suffering from supraorbital neuralgia have been studied through a seven year period. Appropriate investigations ruled out other headaches. There was a female (67%) preponderance. Mean age at onset was 51.6 years. The mean headache duration was 5.9 years. Five patients had a history of ipsilateral forehead trauma. The main areas of pain were the forehead and orbit. The pain was dull with short sharp or burning exacerbations. The temporal pattern was either remitting (n = 7) or chronic continuous (n = 11). Autonomic accompaniments were generally lacking. Neurological assessment was normal in all but 4 patients who were found to have signs/symptoms of sensory dysfunction in the forehead of the symptomatic side. Trials of different drugs, including migraine and anti-neuralgic drugs, only provided slight relief. Anaesthetic nerve blocks of the supraorbital nerve provided an absolute but transitory relief of pain. Although aetiology and pathogenesis of supraorbital neuralgia is largely unknown, entrapment of the supraorbital nerve at its outlet and successful decompressive surgery have been previously reported. This and other pathogenic hypotheses are discussed.     

Peripheral nerve stimulator for the treatment of supraorbital neuralgia: a retrospective case series

Peripheral nerve blocks of the supraorbital, supratrochlear or occipital nerve have been utilized for the relief of headaches, although relief may be short-lasting. The purpose of this study was to evaluate the efficacy of supraorbital nerve stimulation for treatment of intractable supraorbital neuralgia. Patients presenting to the pain clinic with refractory frontal headaches who responded to a diagnostic supraorbital nerve block were selected for this case series. Patients underwent a trial of supraorbital nerve stimulation, and efficacy was assessed after 5–7 days ( n  = 16). From the trial, 10 patients consented to undergo permanent implantation of the stimulator. Opioid consumption and headache scores were monitored preoperatively and at timed intervals for 30 weeks. Headache scores decreased, and opioid consumption was reduced in half, and these beneficial accomplishments were maintained up to 30 weeks after implantation. In selected patients, supraorbital nerve stimulation for the treatment of chronic frontal headaches appears to be efficacious.     

Extracranial Vascular Responses to Sublingual Nitroglycerin and Oxygen Inhalation in Cluster Headache Patients

SYNOPSIS
Photoplethysmography was used to record pulsations from the superficial temporal artery and supraorbital region in 23 patients suffering from cluster headaches, in 10 patients between bouts of headache, and in 10 control subjects. Pulsations were measured before and after the administration of 0.9 mg nitroglycerin sublingually, at the onset and height of cluster attacks and after inhalation of 100% oxygen for 10 minutes. Following nitroglycerin administration, increases in superficial temporal artery pulsations were greater on the symptomatic than on the nonsymptomatic side in patients who later developed headache. This persisted during cluster headache. By contrast, the increase in superficial temporal artery pulsations was greater on the nonsymptomatic side in patients who did not develop headache. The cause of this paradoxical response is unclear. Inhalation of oxygen produced significantly greater reduction of supraorbital pulsations on the symptomatic side in patients with headache. Decreases in both arterial territories following oxygen inhalation were significantly greater during cluster headache than between bouts or than in control subjects.     

颅脑手术后头痛的综合治疗效果

目的观察疼痛科协助下综合治疗颅脑手术后头痛的效果。方法将30例颅脑手术后颅内情况稳定但出现严重头痛的患者随机分为治疗组(n=15,疼痛科协助下行神经阻滞为主的综合治疗)和对照组(n=15,继续神经外科药物治疗)。对两组患者治疗前后疼痛的视觉模拟评分(VAS)、手术后至出院的住院天数以及医疗费用进行比较。结果与对照组比较,治疗组患者治疗后的VAS评分明显降低(P<0.01),手术后至出院的平均住院天数明显减少(P<0.01),检查费和药费明显降低(PP<0.01),床位费亦降低(P<0.05)。结论疼痛科协助下对颅脑手术后头痛患者行神经阻滞为主的综合治疗可明显提高治疗效果,缩短住院时间,降低医疗费用。     

Supraorbital neuralgia. Vågå study of headache epidemiology

In a recent, hospital-based report, we described a small series of 5 patients with unilateral, more or less chronic, severe forehead pain, that could be transitorily abated by anaesthetic blockade of the supraorbital nerve and more permanently abated by 'liberation' operation directed towards the nerve exit area at the supraorbital notch. However, epidemiological data on supraorbital neuralgia are lacking. Among 1838 18-65-year-old inhabitants in V?g? (88.6% of the eligible ones), there were 10 who presented the following clinical picture: (1) Unilateral forehead/ocular pain, not diagnosed or diagnosable as any other, particular, unilateral headache; (2) Steadfast unilaterality; (3) Increased tenderness upon pressure over the exit site of the supraorbital nerve (incisura frontalis) on that side--in those who were in an active phase; (4) Foregoing trauma in the forehead/supraorbital rim area, ipsilaterally. In approximately half the cases, there was a moderate, ipsilateral sensory loss. A striking finding was the occurrence of jabs in the symptomatic area, and in synchrony with the neuralgia pain. These 10 inhabitants correspond to a prevalence of 0.5% (or 0.65% if two nontrauma cases are included).     

Peripheral Neurostimulation in Supraorbital Neuralgia Refractory to Conventional Therapy

▪ Abstract:   Supraorbital neuralgia has been identified as an infrequent cause of headache that may prove very difficult to control pharmacologically. Peripheral nerve stimulation using electrodes to stimulate the nerve segmentally responsible for the zone of pain may constitute a management alternative in such cases. We present the case of a patient with headache because of posttraumatic supraorbital neuralgia, refractory to medical treatment, with good analgesic control after peripheral nerve stimulation.
Peripheral nerve stimulation may be considered a safe, reversible treatment for patients with headache secondary to supraorbital neuralgia who respond poorly to pharmacological treatment, thus avoiding irreversible alternatives such as surgery. ▪     

神经阻滞及局部浸润联合药物治疗带状疱疹后神经痛的疗效观察

目的观察神经阻滞及皮损区局部浸润联合药物治疗带状疱疹后神经痛的疗效。方法选择急性带状疱疹愈合后,疼痛时间持续超过3个月的患者57例,皮损部位分别在头面部、胸背部、上下肢及骶部。采用神经阻滞、皮损区局部浸润联合药物治疗,以视觉模拟评分(VAS)和睡眠质量评分(QS)综合评定治疗效果。结果治疗后第1～4周VAS评分及QS评分较治疗前显著降低(P<0.01)。显效率87.7%,总有效率100%。结论以神经阻滞和皮损区局部浸润联合药物治疗带状疱疹后神经痛,能迅速缓解疼痛,改善睡眠质量且副作用少,是目前较为理想的方法 。     

Greater occipital nerve blockade for cluster headache

Cluster headache is perhaps the most painful of the primary headache disorders. Its treatment includes acute, transitional, and preventive therapy. Despite the availability of many treatments, cluster headache patients can still be difficult to treat. We treated 14 cluster headache patients with greater occipital nerve block as transitional therapy (treatment initiated at the same time as preventive therapy). The mean number of headache-free days was 13.1 + 23.6. Four patients (28.5%) had a good response, five (35.7%) a moderate, and five (35.7%) no response. The greater occipital nerve block was well tolerated with no adverse events. Headache intensity, frequency and duration were significantly decreased comparing the week before with the week after the nerve block (P < 0.003, P = 0.003, P < 0.005, respectively). Greater occipital nerve blockade is a therapeutic option for the transitional treatment of cluster headache.     

急性颅脑损伤后紧张型头痛的综合治疗方法

目的探讨急性颅脑损伤后紧张型头痛的综合治疗效果。方法对14例轻度颅脑损伤后出现重度头痛、按照国际头痛协会诊断标准确定为紧张型头痛的患者,根据查体体征行神经及痛点阻滞,应用曲安奈德10mg配成利多卡因浓度为0.4%的消炎镇痛液,选择相应的压痛点每个点穿刺注射3ml,配合口服塞来昔布和乙哌立松,观察治疗前后头痛程度和持续时间的变化。结果治疗后,患者的头痛发作程度明显减轻,头痛持续时间明显缩短(P<0.01)。结论以神经阻滞为主的综合治疗方法对颅脑损伤后紧张型头痛有明显的疗效。     

神经阻滞技术与周围神经痛

介绍三叉神经痛、舌咽神经痛、枕神经痛、颈椎性神经根痛、肋间神经痛、坐骨神经痛、股神经痛、股外侧皮神经痛、髂腹股沟及髂腹下神经痛等10种周围神经痛的病因和发病机制、临床症状、诊断以及治疗方法。神经阻滞(nerveblock,NB)技术治疗这些疾病是来源于麻醉学的一种独特的方法。当药物疗法或其他方法不见效时改用这种技术可获显著效果,于是详述眶上NB,眶下NB,上颌NB,下颌NB,颏NB,半月神经节乙醇、甘油、热凝NB,舌咽NB,枕NB,肋间NB,腰大肌肌沟阻滞,股NB,股外侧皮NB,髂腹股沟及髂腹下NB等18种NB技术的实施方法。