星状神经节阻滞与头痛患者颈部血流变化的相关性

背景星状神经节阻滞(stellate ganglion block,SGB)现已广泛应用于疼痛性疾病的治疗,其作用机制尚在研究中.目的探讨重症头痛双颈总动脉、双椎动脉血流动力学特征及其与SGB效果的相关性.设计半随机对照、单盲、纵向观察性研究.地点和对象本研究在首都医科大学附属天坛医院完成,研究对象为1998-02/08本院门诊重症头痛患者30例,男女患者各15例.方法门诊重症头痛患者30例为治疗组,非头痛患者30例做对照组.以ASONICS,SPEC-TRA彩色多普勒超声诊断仪,测量两组SGB前,及治疗组阻滞后5 min的双侧颈总动脉和双侧椎动脉血流动力学参数,治疗组SGB前后临床疼痛程度评定采用五点口述分级(VRS-5)记录.主要观察指标血流量、阻力指数、峰值流速、时间平均流速(TAV)、血管内径及治疗组SGB前后疼痛评分.结果治疗组于阻滞后约1 min均有阻滞侧瞳孔缩小;痛侧与对照组比,阻滞前峰值流速(66.14±18.2和46.20±7.21)(P＜0.01),阻力指数(0.74±0.05和0.65±0.05)(P＜0.05),VRS-5(4.5±0.5和0)均显著高于对照组(P＜0.01);阻滞后峰值流速降到59.47±9.21(P＜0.05),阻力指数降到0.65±0.05(P＜0.05),VRS-5降到1.2±0.6(P＜0.01).结论SGB治疗重症头痛效果肯定.本组重症头疼患者有颅脑血管张力异常变化,提示SGB可能通过平衡植物神经,双向调节所支配区域血管张力,使头痛缓解.

Correlation between stellate ganglion block carotid hemodynamics in patients with severe headache

BACKGROUND: The technique of stellate ganglion block(SGB) is used widely in the treatment of painful disease, but its mechanism still remains unkown.OBJECTIVE: To explore the carotid hemodynamic features of patients with severe headache and its correlation with the effect of SGB.DESIGN: A quasi-randomized controlled, single-blind and longitudinal observational trial was conducted.SETTING and PARTICIPANTS: This trial was completed in Tiantan Hospital of Capital University of Medical Sciences. The subjects were 30 outpatients(15 males and 15 females) with severe headache in Tiantan Hospital between February and August, 1998.METHODS: Thirty patients with severe headache were selected as the trial group, and 30 healthy people as the control group. The hemodynamic parameters of bilateral carotid and vertebral arteries were measured by Color Doppler ultrasound ASONICS, SPEC-TRA before SGB and 5 minutes after SGB. The clinical degrees of pain in the trial group before and after SGB were assessed by 5-point verbal rating scale(VRS-5).MAIN OUTCOME MEASURES: Blood flow, resistance index(RI), peak value velocity (PKV), time average velocity (TAV), diameter of blood vessels in both groups and pain scores of the trial group were measured before and after SGB.RESULTS: Miosis at the side of block was observed in the trial group 1 minute after SGB. Before SGB, PKV(66. 14 ± 18.2), RI(0. 74 ±0.05) and VRS-5 (4.5 ± 0. 5 ) of the pain-affected sides were significantly higher in the trial group than in the control group(46.20 ± 7.21, P ＜ 0. 01; 0.65 ±0.05, P ＜ 0. 05; 0, P ＜ 0. 05); after SGB, however, these parameters in the trial group decreased to 59.47 ± 9.21 ( P ＜ 0. 05), 0. 65 ± 0.05 ( P＜0.05) and 1.2±0.6 (P ＜0.01), respectively.CONCLUSION: SGB is effective in the treatment of severe headache. Abnomal cerebrovascular tension was found in the patients with severe headache, so SGB may dually regulate cerebrovascular tension in the dominated location by balancing vegetative nerve, and thus to relieve headache.