复合维生素治疗带状疱疹顽固性疼痛134例疗效分析

目的分析复合维生素治疗带状疱疹顽固性疼痛134例疗效。方法采用神经阻滞，疱疹区域相应神经节段椎旁阻滞相应星状神经节治疗。结果痊愈68例，好转23例，无效43例。结论带状疱疹虽然是自愈性疾病，但早期接受区域神经阻滞治疗，对缓解疼痛，缩短病程，疗效显著，值得临床推广应用。     

星状神经节阻滞加整脊手法治疗偏头痛

采用星状神经节阻滞,阻断交感神经和神经肽Y能神经的异常兴奋,用针刺疗法松解枕、颈、肩、背部粘连结疤的软组织,用整脊手法矫正颈椎椎间关节紊乱,适当用颈围固定,治疗偏头痛32例,随访年以上,有效率为188%28/32)。提(示星状神经节阻滞加整脊手法可舒张头、颈部血管,改善其供血供氧,达到治疗偏头痛的目的。     

半导体激光照射治疗偏头痛50例效果观察

目的:探讨半导体激光照射治疗偏头痛的临床效果.方法:将100例偏头痛患者随机分为A组和B组各50例,A组接受半导体激光星状神经节照射,B组接受星状神经节阻滞,均治疗10 d,治疗结束后对临床疗效进行对比.结果:A组优良率为82.00%,B优良率为88.00%,两组比较无显著差异(P>0.05).A组皮肤灼伤2例,B组喉返神经阻滞6例.结论:半导体激光星状神经节照射治疗偏头痛具有疗效好、安全性高、无明显副作用等优点,值得推广.     

点式直线偏振光照射星状神经节治疗顽固性呃逆的疗效分析

呃逆是由各种刺激因素导致膈肌痉挛所引起的一种反射活动。顽固性呃逆（intractable hiccup）多发生于有器质性疾病的患者，常因严重的膈肌痉挛影响进食、谈话、呼吸和睡眠，易导致胃肠功能紊乱和营养不良等并发症，加之精神和躯体的负担，给患者带来了很大的痛苦。我们采用点式直线偏振光照射星状神经节对顽固性呃逆患者进行治疗，并与星状神经节阻滞治疗者进行对照，现报道如下。     

星状神经节阻滞联合药物治疗头面部带状疱疹的临床疗效

【目的】探讨星状神经节阻滞联合药物治疗头面部带状疱疹的临床疗效。【方法】55例头面部带状疱疹患者随机分为两组,治疗组（n=28,A组）和对照组（n=27,B组）,治疗组采用星状神经节阻滞,联合曲马多、加巴喷丁等药物治疗,对照组采用经典药物治疗。采用VAS评分评估两组患者治疗前后疼痛程度变化。【结果】治疗前,治疗组VAS平均为7．68±0．32,对照组为7．53±0．27;治疗五周后,治疗组VAS平均为2．42土0．26,对照组3．60±0．34。治疗前、后,A组和B组同组内各时间点的VAS分别随时问变化而减少,且两两比较差异均具有显著性（P〈0．05）。治疗后二周起A、B组组间VAs比较,差异均具有显著性（P〈0．05）。【结论】星状神经节阻滞联合药物治疗头面部带状疱疹有效、安全,值得临床推广应用。     

星状神经节阻滞治疗顽固性呃逆的疗效观察

我科自1999-01～2005-07对院内经药物、针灸、咽喉迷走神经刺激等方法治疗无效,持续72 h以上顽固性呃逆患30例,采用星状神经节阻滞的方法,收到了良好的效果,现报告如下.     

星状神经节阻滞结合药物治疗纤维肌痛综合征临床观察

目的探讨氟哌噻吨＋美利曲4-（黛力新）＋阿普唑仑＋星状神经阻滞治疗纤维肌痛综合征（FS）的临床疗效。方法30例患者随机分为A组（黛力新＋阿普唑仑），B组（黛力新＋阿普唑仑＋星状神经阻滞组），观察疗效。果A组优良率76．9％，B组优良率达86．7％，B组疗效明显优于A组。结论星状神经节阻滞结合药物治疗优=纯药物治疗，疗效满意，不良反应少，值得临床推广应用。     

激光星状神经节照射联合经皮神经电刺激治疗脑卒中后吞咽障碍的疗效观察

目的：观察激光星状神经节照射配合经皮神经电刺激治疗脑卒中吞咽障碍的临床疗效。方法：脑卒中吞咽障碍患者100例随机分为A组33例、B组33例及C组34例,A组接受常规神经内科治疗及冰刺激疗法,B组在A组治疗基础上给予经皮神经电刺激疗法,C组在B组治疗基础上增加激光照射星状神经节。分别于治疗前后采用洼田饮水试验对3组患者进行吞咽功能评定,并比较总疗效和胃管留置率的变化情况。结果：治疗4周后,3组患者吞咽功能均较治疗前明显改善（P〈0.05）;且C组优于B组,B组优于A组,组间差异有统计学意义（P〈0.05）。治疗后3组临床疗效比较,C组总有效率高于B组,B组高于A组（94.12%、72.73%、36.36%,P〈0.05）。A、B、C组的胃管留置率均较治疗前明显下降（30.30%、27.27%、41.18%和6.06%、3.03%、0,P〈0.05）,但组间差异无统计学意义。结论：吞咽障碍患者在冰刺激及经皮神经电刺激治疗的基础上辅以激光照射星状神经节治疗效果明显,能进一步提高患者的吞咽功能,明显降低胃管使用率。     

盲法星状神经节阻滞的学习曲线

目的:总结盲法星状神经节阻滞的学习曲线。方法:回顾性收集2012年3月至2012年9月由同一术者连续完成的300例星状神经节阻滞治疗的病例资料,按治疗先后顺序分为A、B、C、D、E 5组,每组60例,从各组霍纳征出现率及并发症发生率等指标比较治疗效果。结果:A、B组的霍纳征出现率明显低于C、D、E组(P<0.05),A、B组的并发症发生率明显高于C、D、E组(P<0.05)。结论:盲法星状神经节阻滞的学习曲线约为120例。     

神经阻滞疗法治疗颈源性头痛的疗效观察

目的:观察神经阻滞治疗颈源性头痛的疗效.方法:颈源性头痛患者30例,均行星状神经节阻滞治疗,有顶枕部疼痛伴颈部僵硬不适加颈椎旁神经阻滞,颞部疼痛或闷胀不适加耳颞神经阻滞.结果:治疗4次后,30例患者头痛完全缓解15例、好转9例、有效4例、无效2例,总有效率93％;VAS评分明显低于治疗前(1.2±1.6与8.0±1.0,P<0.05).结论:星状神经节阻滞并配合局部针对性处理治疗颈源性头痛疗效显著.     

MULTIDISCIPLINARY PAIN ABSTRACTS: 4

Stellate ganglion block is a procedure frequently used for the management of patients with chronic sympathetically mediated pain affecting the arm, neck or head. In this study, the authors looked at the effect of the stellate ganglion block on ipsilateral phrenic nerve function, and hence diaphragmatic strength, in 11 adult patients with chronic sympathetically mediated pain. Pre-block and post-block forced vital capacity (FVC) measurements were recorded using a pneumotachograph and a Magstim nerve stimulator was used to generate pre-block and post-block twitch mouth pressures (P[TWM]). This device can be used to stimulate the phrenic nerves and hence the diaphragm. The resulting change in airway pressure was measured at the mouth and has previously been shown to reflect diaphragm strength. There was no statistically significant difference in FVC or P(TWM) before or after the stellate ganglion block. In conclusion, a stellate ganglion block has no adverse effect on ipsilateral phrenic nerve function or diaphragm strength in healthy adult patients.     

Somatosensory evoked potentials are unchanged by reflex sympathetic dystrophy and by stellate ganglion block.

Median nerve somatosensory evoked potentials (SEPs) were monitored in patients with chronic pain before and after stellate ganglion blockade. A change caused by the syndrome or by the block would suggest that SEPs might be useful in the diagnosis and treatment of chronic pain. We observed 20 subjects. Group I (n = 10) had chronic pain not involving the upper extremity. Group II (n = 8) had reflex sympathetic dystrophy of the arm. All patients underwent unilateral stellate ganglion block using an anterior paratracheal approach. The SEPs were recorded by median nerve stimulation on the blocked (affected) side and unblocked (unaffected) side before and 30 min after the block. Recording sites were ipsilateral brachial plexus, the cervical spinal cord, and the contralateral sensory cortex. There were no between-group differences before or after the block. Paired analysis within each group showed that the SEPs were not different from baseline (unaffected side before block) at any time throughout the study. We conclude that since SEPs are not changed by the reflex sympathetic dystrophy or stellate ganglion block, they would not be useful in the evaluation of pain or in determining the effectiveness of sympathetic block. Both the pain and the block appear to involve alteration of conducting pathways separate from those monitored by median nerve SEPs.     

星状神经节阻滞与颈横突局部注射疗法对颈源性头痛的疗效评价

目的:探讨星状神经节阻滞疗法和C2横突旁注射疗法对颈源性头痛的疗效.方法:颈源性头痛患者96例分别采用C2横突局部注射36例(A组)、星状神经节阻滞36例(B组)及单纯口服对乙酰氨基酚胶囊24例(C组).治疗前后采用McGill疼痛评分量表评定患者疼痛程度.结果:治疗3周后,A、B组疼痛评分差异无显著性意义,但均优于C组(P＜0.05).结论:C2横突旁局部注射与星状神经节阻滞疗法治疗作用相近,对颈源性头痛均有较好疗效.     

电针结合星状神经节阻滞治疗椎动脉型颈椎病

目的:观察电针结合合星状神经节阻滞治疗椎动脉型颈椎病患者的临床疗效。方法:120例椎动脉型颈椎病患者随机分为3组,电针组40例用电针刺激体穴结合C3-5夹脊穴治疗;阻滞组40例采用利多卡因注射液5ml及0.9%生理盐水5ml的混合液星状神经节阻滞治疗;综合组40例则结合2种方法综合治疗。治疗前后以临床症状评分量表评定疗效。结果:治疗2周后临床症状积分,综合组明显低于电针组和阻滞组(P<0.05),治愈率和总有效率高于电针组和阻滞组(P<0.05,0.01)。结论:电针配合星状神经节阻滞治疗椎动脉型颈椎病能明显改善患者临床症状,提高治疗效果。     

家兔全脑缺血再灌注期血清白细胞介素6水平与星状神经节阻滞的关系

背景星状神经节阻滞可改善脑循环,调节免疫,降低血浆儿茶酚胺浓度,白细胞介素6是机体急性应激反应中最敏感重要的标志和介导物之一,在脑缺血性损伤中扮演着神经保护和神经毒性的双重作用.目的观察星状神经节阻滞对家兔全脑缺血再灌注期间血清白细胞介素6含量的影响,探讨星状神经节阻滞对全脑缺血再灌注损伤的作用效应.设计随机对照的动物实验.单位郧阳医学院附属太和医院麻醉科、郧阳医学院附属人民医院麻醉科.材料实验于2003-03在郧阳医学院实验中心及附属太和医院神经科学研究所进行动物实验,白细胞介素6检测试剂盒及测定工作由中国人民解放军总医院放射免疫研究所提供和协助完成.选择健康日本大耳白免28只,雌雄不拘,随机分成星状神经节组、盐水对照组、空白对照组和假手术组,每组7只.方法用手术法在所有动物星状神经节旁置入一导管,用六血管阻断法制作全脑缺血再灌注模型,星状神经节阻滞组在缺血15 min后松开动脉夹再灌注开始,同时从导管持续泵入2.5 g/L的布比卡因行左侧星状神经节阻滞,生理盐水对照组和空白对照组分别在松开动脉夹时从导管泵入生理盐水代替布比卡因和不用药,假手术组仅完成相应的手术操作而不夹闭动脉.采用放射免疫法测定缺血前、再灌注10 min,4,10,20及30时血清白细胞介素6的水平.主要观察指标各组实验动物在再灌注后各时点白细胞介素6水平变化.结果纳入本次实验的28只大耳白兔全部进入结果分析.白细胞介素6在各组均呈上升趋势,星状神经节阻滞组仅在再灌注30 h时高于假手术组,差异有显著性[(321±52)和(299±45)ng/L,P＜0.05];与缺血前比较,生理盐水对照组在再灌注4 h开始显著升高[(365±46)ng/L],空白对照组在再灌注10 h以后出现显著性升高[(368±31)ng/L,P＜0.05].星状神经节阻滞组与假手术组,生理盐水对照组与空白对照组组间差异无显著性(P＞0.05);生理盐水对照组和空白对照组白细胞介素6水平在再灌注4～30 h时均高于假手术组,在再灌注10 h以后高于星状神经节阻滞组,差异均有显著性(P均＜0.05).星状神经节阻滞组白细胞介素6升高的水平较生理盐水对照组、空白对照组显著降低(P＜0.05).结论星状神经节阻滞可明显降低家兔全脑缺血再灌注期间血清白细胞介素6的水平,提示星状神经节阻滞对全脑缺血再灌注损伤具有一定的保护和治疗作用,可作为治疗脑缺血再灌注损伤的一种新的途径.     

The effects of neomycin upon transmitter release and action.

These experiments were designed to determine the site and mechanism of action of neomycin on cholinergic transmission. These agents depressed the response of rat diaphragm preparations to phrenic nerve stimulation and to injected acetylcholine (ACh); however, equi-effective neuromuscular blocking concentrations of neomycin (6 x 10(-4) M), streptomycin (1.2 x 10(-3) M) or d-tubocurarine (6.5 x 10(-7) M) reduced the muscle response to injected ACh to 54,27 and 15% of control, respectively, suggesting that neomycin and streptomycin have a presynaptic effect. This finding was confirmed by measuring ACh release from the diaphragm during phrenic nerve stimulation; neomycin (6x10(-4) M) and streptomycin (1.2 x 10(-4) M) depressed ACh release to 29 and 41% of control, respectively. In the cat superior cervical ganglion neomycin (2 x 10(-3) M) blocked ganglionic transmission, did not reduce the response of ganglion cells to injected nicotine and depressed ACh release during preganglionic nerve stimulation to 61% of control in normal Ca++ (2.5 mM) medium and to less than 10% of control in low Ca++ (0.5 mM) medium. The increased accululation of 45Ca induced in rat isolated ganglia by preganglionic nerve stimulation was not changed by d-tubocurarine (2 x 10(-4) M), but was abolished by neomycin (2 x10(-3) M). It is concluded that neomycin blocks ACh release by blocking the influx of Ca++ necessary for transmitter release. This conclusion suggested that neomycin should block noradrenaline release, and this was shown using the anococcygeus preparation from the rat.     

三维虚拟穿刺仿真在颈部神经阻滞中的应用

背景:颈部神经阻滞麻醉易引起严重麻醉意外与并发症,目前在建立颈部神经三维可视化模型并对颈部神经节阻滞进行虚拟仿真方面还处在临床探索阶段。目的:寻求三维虚拟穿刺仿真在颈部神经阻滞中的应用方法。方法:取健康志愿者颈部连续CT动脉造影/MRI脊髓造影断面图像,Mimics软件对骨骼、肌肉、动静脉、甲状腺、喉软骨、脊髓等组织进行半自动分割和重建,医学计算机辅助设计模块对神经等细小解剖结构进行重建,三维化显示颈部神经及周围相关解剖结构,并进行颈部神经穿刺虚拟仿真,包括模拟颈浅丛阻滞,颈深丛阻滞和星状神经节阻滞。结果与结论:成功模拟颈浅丛阻滞,颈深丛阻滞和星状神经节阻滞,显示虚拟穿刺针和骨性结构、动静脉、肌肉、脊髓、颈丛深浅支和星状神经节等解剖结构的三维毗邻关系,并测量穿刺进针的安全角度,深度和最佳穿刺路径。说明三维虚拟穿刺仿真技术可以为颈部神经阻滞术提供直观的形态学参考。     

颈椎牵引加运动疗法治疗神经根型颈椎病疗效观察

目的评价运动疗法对神经根型颈椎病的疗效。方法50例患者随机分为治疗组30例（牵引加运动疗法治疗），对照组20例（单纯颈椎牵引治疗），进行疗效比较。结果治疗组痊愈12例，显效11例，有效8例，无效1例；对照组痊愈6例，显效5例，有效4例，无效无效5例（P〈0．05）。结论牵引与运动疗法联合应用可能取得更佳疗效。     

Neural prostheses in the respiratory system.

Approximately 5% of spinal cord-injured individuals suffer from respiratory muscle paralysis and require chronic mechanical ventilation. Unfortunately, this form of life support is associated with a number of undesirable side effects and discomforts. The only available alternative to mechanical ventilation is diaphragm pacing via bilateral phrenic nerve stimulation. This technique can provide patients with marked improvements in life quality and offers significant advantages compared to mechanical ventilation. Many patients, however, do not have bilateral phrenic function or are not willing to accept the risks inherent with phrenic nerve pacing and therefore are not candidates for this technique. Two alternative methods to ventilate patients with ventilator-dependent tetraplegia are reviewed in this paper. In patients with only a single functional phrenic nerve who are therefore not candidates for phrenic nerve pacing, combined intercostal muscle and unilateral phrenic nerve stimulation has recently been shown to maintain ventilatory support. In patients with bilateral phrenic nerve function, on-going studies suggest that intramuscular diaphragm pacing may be a useful alternative to direct phrenic nerve pacing. With the electrodes placed into the diaphragm laparoscopically, this method allows for the diaphragm to be activated without manipulation of the phrenic nerve, need for thoracotomy, or hospitalization. Both techniques provide benefits similar to that derived from bilateral phrenic nerve pacing and hold promise as alternative methods of ventilatory support in selected populations groups.     

神经阻滞与苯巴比妥治疗失眠对照研究

目的：神经阻滞与苯巴比妥治疗失眠的疗效比较.方法：将128例失眠患者随机分为神经阻滞组和苯巴比妥组各64例.神经阻滞组采用神经阻滞（星状神经节阻滞＋双枕大神经阻滞）,每日一次,15次为一疗程.苯巴比妥组每晚睡前30 min口服苯巴比妥分别为15 mg、30 mg、60 mg,最大剂量达90 mg,15天为一疗程.观察两组疗效的差别.结果：神经阻滞组和苯巴比妥组在治疗一疗程后与治疗前比较差异非常显著（P＜0.01）.治疗后两组间比较差异也非常显著（P＜0.01）.结论：神经阻滞治疗失眠疗效明显优于口服苯巴比妥,且神经阻滞组治愈率高,复发率低,副作用少,无耐药性和依赖性.