椎旁阻滞在疼痛治疗中的临床应用

椎旁阻滞是将药物注射到椎旁间隙,达到阻滞相应脊神经根的作用,可适用于颈,胸和腰不同部位的多种疼痛治疗,本文就椎旁阻滞的适应证、合并症及临床应用作一综述。     

椎旁神经阻滞与竖脊肌平面阻滞在腔镜食管癌根治术中镇痛作用的比较

目的:观察竖脊肌平面阻滞（erector spinae plane block, ESPB）与椎旁神经阻滞（paravertebral nerve block, PVB）对腔镜食管癌根治术患者术后急慢性疼痛的影响。方法:择期腔镜下行食管癌根治术的患者138例,采用随机数字表法分为椎旁神经阻滞组（P组）、竖脊肌平面阻滞组...     

星状神经节配合椎旁阻滞治疗椎动脉型颈椎病的临床观察

椎动脉型颈椎病（Cervical Spondylotic Vertebral Arteriopathy,CSA）是影响人类健康的常见病、多发病,是由多种原因引起椎动脉受压和发生弯曲、痉挛,或伴有椎动脉粥样硬化及转动牵拉椎动脉时,引起椎-基底动脉供血不足的症状。星状神经节阻滞能改善颈总动脉血流量,     

颈6椎横突前（颈中）交感神经节阻滞治疗偏头痛100例报告

偏头痛是神经内科最常见的病种之一，过去偏重于药物治疗，近年来不少医院麻醉科采用星状神经节阻滞(SGB)治疗，取得显着疗效。鉴于星状神经节位于颈7横突前至第一肋骨，部位较深，阻滞操作稍有不慎，有可能刺破胸膜造成气胸、阻滞喉返神经造成发声嘶哑、局部血肿和椎管内误注局麻药等严重并发     

超声引导下椎旁神经阻滞与肋间神经阻滞用于胸腔镜肺部术后镇痛效果的比较

目的 探讨超声引导下椎旁神经阻滞与肋间神经阻滞对胸腔镜术后镇痛效果的影响。方法 选取2016年1月至2018年12月择期行胸外科手术患者1 190例,男516例,女674例,年龄18~75岁,BMI 15~35 kg/m²,ASA Ⅰ—Ⅲ级。根据接受神经阻滞的类型分为两组：椎旁神经阻滞组（P组,n=327例）和肋间神经阻滞组（I组,n=863例）。P组术前行T3-4和T6-7椎旁神经阻滞;I组于手术结束时在胸腔镜监测下在切口及其相邻上下两个肋间实施肋间神经阻滞。记录患者性别、年龄、身高、体重,既往合并症,术后第1、2和3天舒芬太尼用量和镇痛泵有效按压次数,术后第1、2和3天静息和活动时疼痛数字（NRS）评分、恶心呕吐,记录术后头晕发生率和术后住院时间。结果 与I组比较,P组术后第1和2天舒芬太尼用量明显减少（P<0.05）,术后第1天镇痛泵有效按压次数明显减少（P<0.05）,术后第1天活动时NRS评分、恶心呕吐发生率明显降低（P<0.05）,术后头晕发生率明显降低(P<0.05),术后住院时间明显缩短（P<0.05 ）。术后第2和3天两组静息和运动时NRS评分、恶心呕吐发生率差异无统计学意义。结论 与肋间神经阻滞比较,椎旁神经阻滞可以减少胸腔镜肺部术后阿片类药物的用量,减少术后不良反应,缩短术后住院时间。     

股神经联合椎旁神经阻滞在高龄患者髋关节手术中的应用

目的 评价股神经、胸腰椎旁神经联合阻滞在高龄患者髋关节手术的应用价值. 方法 将65例行髋关节术的70岁以上患者按抽签法随机分为全身麻醉（general anesthesia,GA）组、椎旁神经阻滞（paravertebral block,PVB）组,PVB组分别于股神经和T12、L3椎体行PVB,采用周围神经刺激器定位,局麻药为0.375％罗哌卡因与1％利多卡因混合液10 ml,并留置导管.GA组采用全凭静脉全身复合麻醉.比较两组患者手术开始30 min、手术结束时的平均动脉压（mean arterial pressure,MAP）、心率（heart rate,HR）和心肌氧耗指数以及术后送重症监护病房（intensive care unit,ICU）、留置导尿、视觉模拟评分（visual analogue scale,VAS）、复苏室评分、术后下呼吸道感染情况. 结果 两组患者术前一般情况、美国麻醉医师协会（ASA）分级、手术时间、MAP、HR和心肌氧耗指数差异无统计学意义.手术开始30 min HR和心肌氧耗指数GA组比PVB组低（P＜0.05）,HR分别为（68±11）次/min和（80±11）次/min、心肌氧耗指数（8 807±1 883）和（10 362±2 433）.与麻醉前比较,两组患者MAP、HR和心肌氧耗指数的变化均显著降低（P＜0.05）.PVB组在手术后的MAP、HR和心肌氧耗指数均低于GA组（P＜0.05）,MAP分别为（88±12） mmHg（1 mmHg=0.133 kPa）和（101±15） mmHg、HR（75±11）次/min和（84±19）次/min、心肌氧耗指数（9 706±2 009）和（12 687±4 119）.与麻醉前比较PVB组MAP、HR及心肌氧耗指数低于术前（P＜0.05）,GA组差异无统计学意义.PVB减少术后需送ICU、下呼吸道感染及留置导尿人数,与GA比较,差异有统计学意义（P＜0.05）. 结论 股神经、胸腰椎旁神经联合阻滞可以安全有效地应用于高龄患者的髋关节手术,其生理干扰轻微,且术后需送ICU及留置导尿概率小,有效降低下呼吸道感染,有效降低心肌氧耗指数,提高了术后患者的安全性和舒适度.     

比较全麻复合超声引导下椎旁神经阻滞与全麻复合胸段硬膜外阻滞应用于开胸手术的效果

目的比较全麻复合超声引导下椎旁神经阻滞与全麻复合胸段硬膜外阻滞应用于开胸手术的效果。方法选取2017-03-2018-05间行开胸手术的166例患者,根据麻醉方法不同分为2组,每组83例。A组施行全麻复合超声引导下椎旁神经阻滞,B组施行全麻复合胸段硬膜外阻滞。结果 (1)麻醉前(T0)时2组MAP水平差异无统计学意义(P>0.05);切皮后15 min(T1)、30 min(T2)、45 min(T3),2组MAP水平均较T0时降低,但A组较B组高,差异有统计学意义(P<0.05)。(2)A组舒芬太尼用量及苯福林使用例数均较B组少,差异有统计学意义(P<0.05)。(3)术后3 h、6 h、12 h、24 h,2组安静状态下VAS评分均低于3分,差异无统计学意义(P>0.05);但A组咳嗽状态下VAS评分较B组高,差异有统计学意义(P<0.05)。结论超声引导下椎旁神经阻滞与胸段硬膜外阻滞在胸科手术镇痛方面均具有良好效果,且胸段硬膜外阻滞在术后咳嗽状态下镇痛效果更佳,而椎旁神经阻滞在降低术中应激反应、减少舒芬太尼用量及苯福林使用例数方面优势更明显,更有利于促进手术顺利进行。     

超声引导竖脊肌平面阻滞与椎旁神经阻滞治疗老年带状疱疹性神经痛：随机对照非劣效性研究

目的:观察对比超声引导竖脊肌平面阻滞（erector spinae plane block, ESPB）与超声引导椎旁神经阻滞（paravertebral nerve block, PVB）治疗老年带状疱疹性神经痛的疗效。方法:90例老年带状疱疹患者,按随机数字表法分为竖脊肌平面阻滞组（E组）和椎旁神经阻滞组（P组）,...     

颈浅丛神经阻滞联合椎旁或肌间沟臂丛神经阻滞在锁骨骨折手术中的应用

目的 比较椎旁神经阻滞联合颈浅丛神经阻滞与肌间沟臂丛神经阻滞联合颈浅丛神经阻滞用于锁骨骨折手术的麻醉效果.方法 选择单侧锁骨骨折的手术患者60例,ASA Ⅰ或Ⅱ级,年龄20～56岁,体重47～78 kg,随机均分为A、B两组:A组行椎旁神经阻滞联合颈浅丛神经阻滞,B组行肌间沟臂丛神经阻滞联合颈浅丛神经阻滞.神经阻滞液含1％利多卡因和0.2％罗哌卡因.A组以T1横突为定位标志行颈椎椎旁+胸椎椎旁神经阻滞,分别用神经阻滞液4 ml和10 ml,再行颈浅丛神经阻滞,用神经阻滞液6 ml.B组行肌间沟臂丛神经阻滞联合颈浅丛神经阻滞,分别采用神经阻滞液15 ml和6 ml.记录椎旁神经阻滞和臂丛神经阻滞15 min后神经所支配区域的感觉阻滞情况、麻醉效果评价和并发症情况.结果 两组C5、C6、T2神经阻滞完善率差异均无统计学意义;C4神经阻滞完善率A组明显低于B组(P＜0.01);C7、C8、T1神经阻滞完善率A组明显高于B组(P＜0.05或P＜0.01).两组患者麻醉效果优良率A组明显高于B组(P＜0.05).A组并发症发生率明显高于B组(P＜0.01).结论 对锁骨骨折手术采用椎旁神经阻滞联合颈浅丛神经阻滞,操作简单安全,神经支配区域阻滞完善率高.     

椎旁神经阻滞配合牵引治疗腰椎间盘突出症的疗效观察

目的比较和评价3种方法治疗腰椎间盘突出症的方法和疗效。方法 90例腰椎间盘突出症患者,男58例,女32例,年龄18～65岁,根据治疗方法不同随机分为3组。A组(20)例采用腰椎旁神经阻滞治疗,B组(20)例采用骨盆牵引治疗,C组(50)例采用以上2种方法综合治疗。治疗3个月后复查,评定3组治疗效果。结果 A、B、C3组治疗效果总有效率依次为70%、40%、92%。C组总有效率与其他2组相比(P0.05)。结论采用椎旁神经阻滞注药配合骨盆牵引治疗腰椎间盘突出症疗效优于单一治疗,两者结合是治疗腰椎间盘突出症的一种比较理想的非手术方法。     

Contrast radiography and effects of thoracic sympathetic ganglion block

Thoracic sympathetic ganglion block is less effective than lumbar sympathetic ganglion block due to differences in the anatomical structure of these regions. Contrast radiographic findings and an analysis of the effects of lumbar sympathetic ganglion block have been reported, but there are few reports concerning thoracic sympathetic ganglion block. The relationship between contrast radiography findings and the effects of thoracic sympathetic ganglion block were studied in 131 block procedures which mainly had hyperhidrosis.(Ohseto K: Contrast radiography and effects of thoracic sympathetic ganglion block. J Anesth 5: 132–141, 1991)     

Three cases of reflex sympathetic dystrophy in the lower extremity treated with lumbar sympathetic ganglion block

Key words  reflex sympathetic dystrophy - lumbar sympathetic ganglion block - plantar core temperature     

Efficacy of thoracic sympathetic ganglion block and prediction of complications: Clinical evaluation of the anterior paratracheal and posterior paravertebral approaches in 234 patients

In the 10 years from 1980 to 1989, a total of 234 patients underwent 557 thoracic sympathetic ganglion blocks. The block was performed by the anterior paratracheal approach in 129 cases and by the posterior paravertebral approach in 428 cases. The procedures for using these two approaches are presented here. The efficacy of thoracic sympathetic ganglion blockade was evaluated as follows; marked efficacy was defined by the complete control of sweating in the palms, moderate efficacy was defined by a decrease in palmar sweating which persisted for at least one week, and minor efficacy was defined by a decrease in sweating followed by recurrence of hyperhidrosis within one week with maintenance of palmar warmth. in addition, the results were retrospectively reviewed in relation to the age and sex of the patients, the technique used, the laterality of the block, the disease treated, the doses of local anesthetic and neurolytic agents, and the number of blocks. The posterior approach was significantly more successful than the anterior approach, and the treatment of both T2 and T3 by the posterior approach was significantly more effective than the treatment of either nerve alone by the same approach (P 0.01). The efficacy rate was significantly lower for hyperhidrosis than for the other diseaces (P 0.01). Complete cessation of hyperhidrosis was significantly less common in the over-60 age group (P 0.01). Regarding the dose of neurolytic, the complete cessation of hyperhidrosis was achieved significantly more frequently with doses of 2.5ml or higher than with lower doses (P 0.01) when both T2 and T3 wee treated by the posterior approach. A dose-dependent response if hyperhidrosis was noted at dose levels higher than 2.5ml. Thoracic sympathetic ganglion blockade was only occasionally associatid with complications, and no serious complications were observed. Before injecting the neurolytic agent, a mixture of contrast medium and local anesthetic was injected to determine the three-dimensional distribution of the contrast and to assess the scope of the analgesia produced by the local anesthetic. Significant complications could thus be avoided.(Ohseto K: Efficacy of thoracic sympathetic ganglion block and prediction of complications: Clinical evaluation of the anterior paratracheal and posterior paravertebral approaches in 234 patients. J Anesth 6: 316–331, 1992)     

The neck crease as a landmark of Chassaignac's tubercle in stellate ganglion block: anatomical and radiological evaluation

BACKGROUND: Stellate ganglion block (SGB) is most commonly performed at the transverse process of the sixth cervical vertebra, the identification of which could be difficult in patients with short and wide necks. This study was conducted to evaluate whether the neck skin crease is a reliable indicator of the C6 level. METHODS: Forty-nine relatively obese pain clinic patients were investigated. They assumed a standard position for SGB. A radiopaque wire was placed along the neck skin crease caudad to the thyroid cartilage. Next, a radiopaque indicator was placed on the skin above the tubercle found to be most prominent by palpation. X-rays of the neck were obtained after each procedure. RESULTS: The probability that the neck crease would cross C5, C6 and C7 was 16%, 71%, and 12%, respectively. The most prominent tubercle corresponded to the C5, C6 and C7 levels in 16%, 69% and l4% of cases, respectively. CONCLUSION: The studied means to identify the C6 transverse process was found to correlate well with each other (P<0.001). Since in 30% of cases the C6 process could not be identified by any of the studied means, radiological guidance is recommended in order to ensure optimal safety and efficacy of SGB in selected cases.     

Effects of lumbar sympathetic ganglion block for a patient with amyotrophic lateral sclerosis (ALS)

A 59-year-old man with amyotrophic lateral sclerosis (ALS) received lumbar epidural and sympathetic ganglion blocks to increase regional blood flow and improve his clinical symptoms. After a lumbar epidural block (0.5% mepivacaine), the skin temperature of his affected lower extremities rose by 7.0°C and became close to that of the intact side, and the distance he was able to walk with his cane increased from 2 to 8 m. The clinical effects produced by the lumbar sympathetic ganglion block (99.5% alcohol) were sustained for approximately 8 weeks after the first block and for approximately 6 weeks after the second block. There were no particular adverse effects or complications associated with these nerve block procedures. Epidural and sympathetic ganglion blocks for an ALS patient, albeit their effects are of a transient nature, may improve related clinical symptoms, and were thought to play a contributory role in improving our patient's quality of life.     

Statistical analysis of visual prognosis following stellate ganglion block treatment on patients with retinal vessel obstruction

The visual outcome in 308 patients treated for retinal vessel obstruction was examined retrospectively and the effectiveness of each treatment was evaluated using stepwise multiple linear regression analysis and the chi-square test. Visual acuity was used as the parameter for assessing treatment effectiveness and the variables investigated included treatment factors [stellate ganglion block (SGB), urokinase administration, and prostaglandin administration] and patient factors (age, duration of visual impairment before treatment, hypertension, and diabetes mellitus). SGB treatment, the duration of visual impairment, and the presence of diabetes mellitus were significantly correlated with the visual prognosis following treatment. These results support the current hypothesis that SGB is a viable treatment for patients with obstructive disease of the retinal vessels.     

星状神经节阻滞对术后认知功能障碍的影响

背景术后认知功能障碍(postoperative cognitive dysfunction,POCD)的发生率已日趋升高.近年来,针对POCD已展开了许多研究,发现星状神经节阻滞(stellate ganglion block,SGB)对POCD有重要作用.目的综述SGB对POCD的影响,旨在为临床上研究POCD的防治提供可能的理论依据.内容SGB是临床较常用的一种阻滞技术,其治疗范围越来越广泛,治疗效果也越来越确切,不仅应用于疼痛性疾病的治疗,也日益广泛地用于神经性、内分泌性及免疫障碍性等非疼痛疾病的治疗,并取得相当显著的疗效,研究发现它对POCD有重要作用. 趋向尽管至今POCD的病因和发病机制仍不清楚,但SGB在防治老年患者POCD方面有较大的研究空间.     

星状神经节阻滞治疗原发性痛经的临床研究

目的 探讨星状神经节阻滞(stellate ganglion block,SGB)对原发性痛经(primary dysmenorrheal,PD)的治疗效果及其作用机制.方法 选择2007年10月-2011年6月,某医学院校护理学专业PD患者76例,采用SGB治疗.于行经前7d开始,月经来潮3d后停止,每日1次,左右交替进行,共治疗3个月经周期,即3个疗程.比较治疗开始前上次月经来潮24h内(T0)、第1疗程月经来潮24h内(T1)、第2疗程月经来潮24 h内(T2)、第3疗程月经来潮24h内(T3)、第3疗程结束后3个月月经来潮24 h内(T4)的视觉模拟评分法(visual analog scale,VAS)评分,睡眠影响指数(sleep interference scale,SIS)变化,同时于以上各时点静脉采血,酶联免疫吸附法(ELISA)测定血清前列腺素F2α(prostaglandin F2α,PGF2α)浓度、前列腺素F2α/前列腺素E2(prostaglandin F2α/prostaglandin E2,PGF2α/PGE2)比值.结果 T1、T2、T3、T4 VAS分别为(1.83±0.52)、(1.48±0.21)、(1.25±0.14)、(1.30±0.25),与T0(6.35±1.42)比较,明显降低,差异有统计学意义(P＜0.01).T1、T2、T3、T4 SIS分别为(1.52±0.41)、(1.40±0.22)、(1.12±0.11)、(1.33±0.24),与T0(6.55±1.32)比较,明显降低,差异有统计学意义(P＜0.01).T1、T2、T3、T4血清PGF2α分别为(5.1±1.1)、(4.9±1.2)、(4.8±1.6)、(4.9±1.7)μg/L,与T0(15.3 ±2.1)μg/L比较,差异有统计学意义(P＜0.05).T1、T2、T3、T4血清PGF2α/PGE2比值分别为(2.1±1.3)、(1.9±1.4)、(1.8±1.1)、(2.1±1.3),与T0(5.2±1.6)比较,差异有统计学意义(P＜0.05).结论 SGB治疗PD,具有降低疼痛、改善睡眠的临床效果,疗效相对稳定,其作用机制可能与SGB降低经期血清PGF2α浓度、PGF2α/PGE2比值有关.     

颈交感神经干离断对妊娠大鼠及胎鼠的影响

目的　研究颈交感神经干离断对妊娠大鼠及胎鼠的影响 ,为孕妇应用星状神经节阻滞治疗疾病提供实验及理论依据。方法　妊娠的Wistar大鼠 6 3只 ,随机分 5组 :对照组 (n =13) ,实验组 1(n =13) ,实验组 2 (n =13) (分别于孕 13d、16d行颈交感神经干离断 ) ,假手术组 1(n =12 ) ,假手术组 2 (n =12 ) (只行颈交感神经干暴露、分离 ) ,观察孕鼠及胎鼠的变化。结果　各组孕鼠饮水量、食量、尿量随妊娠天数的增加而增加 ,血压随妊娠天数的增加而略有下降 (P >0 0 5 )。胎鼠体重、身长、畸形率、死亡率、胎盘重量、直径及孕鼠血中去甲肾上腺素和游离雌三醇的含量组间也无显著性差异 (P >0 0 5 )。结论　在孕中期或晚期行颈交感神经干离断对孕鼠的内分泌、植物神经系统及胎鼠的生长发育无不良影响