CT引导下胸、腰交感神经联合阻滞技术治疗手、足多汗症  

Combined thoracic and lumbar sympathetic nerve blocks guided by CT in Wearing palmar and plantar hyperhidrosis

作　　者：黄冰[1] 过建国[1] 任小姝[1] 姚明[1] 张利[1] 费勇[1] 谢可越 周煦燕[1] 陆雅萍[1] 邓甲甲 倪华栋[1] 

机构地区：[1]浙江省嘉兴市第一医院疼痛医学科,314000

出　　处：《中华神经医学杂志》2015年第10期1055-1058,共4页Chinese Journal of Neuromedicine

基　　金：浙江省卫生高层次人才基金（2012-RC-22）;浙江省医药卫生一般项目（2014-KYB-269）;浙江省中西医结合疼痛医学创新学科建设计划项目（2012-AK-31）;2015年浙江省医药卫生省部培育计划（2015PYA010）

摘　　要：目的观察CT引导下胸、腰交感神经联合阻滞治疗手、足多汗症的临床效果。方法浙江省嘉兴市第一医院疼痛医学科自2013年1月至2014年12月采用CT引导下胸、腰交感神经联合阻滞治疗手、足多汗症23例，穿刺点为T3-4、L2-3椎间隙，分别抵达T4肋骨小头上方、L3椎体前外侧与腰大肌前方，胸、腰交感神经旁分别注入含造影剂碘海醇的10g／L利多卡因2mL、3mL，CT扫描胸、腰段所注药液分别分布在T4肋骨小头前方、腰大肌与椎体之间，患者手指、脚趾末梢灌注指数（PD上升5倍以上和双手、脚掌温度上升3℃以上时，再分别注入含造影剂碘海醇的无水乙醇3mL、5mL。比较患者注药前后各生理指标的变化并判定疗效。结果23例患者均在CT定位穿刺引导器的引导下穿刺至各个靶点。与用药前比较，用局麻药后5min、用无水乙醇后5min患者食指、脚趾的PI和双手掌、足掌温度均增加，但用无水乙醇后5min患者食指、脚趾的PI和双手掌、足掌温度低于用局麻药后5min时，差异均有统计学意义肚0．05）。术后随访1年内患者效果优良21例（86．96％），复发3例（13．04％）。结论CT引导下胸、腰交感神经联合阻滞技术可有效治疗手、足多汗症。Objective To evaluate the clinical effects of CT guided thoracic sympathetic nerve block combined with lumbar sympathetic nerve block on palmar and plantar hyperhidrosis. Methods Twenty-three patients with palmar and plantar hyperhidrosis, received combined thoracic and lumbar sympathetic nerve blocks in our hospital from January 2013 to December 2014, were chosen. Under CT guidance, thorocic intervertebral puncture was performed between T3 and T4 till the needle tip reached the spot around T4 and above capitis costae; lumbar intervertebral puncture was performed between L2 and L3 till the needle tip reached the lateral side of L3 and the anterior side of the psoas muscle. Two mL and 3 mL 1% lidocaine containing contrast agent iohexol were injected adjacently to thoracic and lumbar sympathetic nerves, respectively. The injected liquid was observed to be distributed in front of T4 capitis costae, or between the psoas muscle and the verterbrae of L3. The patient＇s finger and toe tip perfusion index （PI） was elevated more than 5 folds; the temperature of hands and feet increased more than 3 ℃. Then, the patients received 3 mL and 5 mL anhydrous alcohol （containing iohexol）, respectively, at thoracic and lumbar puncture points for CT scanning and three-dimensional reconstruction of the physic liquor distribution. Results CT could precisely guide the puncture needle to reach the target in these23 patients. As compared with those before medication, the finger and toe tips perfusion indexes and temperatures of palmar and plantar surfaces at 5 min after injection of local anesthetics and 5 min after anhydrous alcohol were significantly increased （P〈0.05）; significant differences of them were noted between injections of local anesthetics and anhydrous alcohol （8.03±1.44 vs. 4.94±1.65, 33.35±1.79 vs. 32.94±1.54, P〈0.05）. One year after follow up, the rate of excellent and good therapeutic effects was 86.96% （n=21）; and 1-year recurrence rate was 13.04% （n=3） without any complications. Co

关 键 词：自主神经 胸交感神经 腰交感神经 CT引导 穿刺 手、足多汗症 

分 类 号：R745[医药卫生—神经病学与精神病学]