影像引导下蝶腭神经节联合选择性颈神经阻滞治疗蝶腭神经痛的回顾性分析  

Retrospective analysis of image-guided sphenopalatine ganglion combined with selective cervical nerve block in the treatment of sphenopalatine neuralgia

作　　者：赖光辉[1] 张达谦 倪家骧[1] Lai Guanghui;Zhang Daqian;Ni Jiaxiang(Department of Pain Management, Xuanwu Hospital,Capital Medical University, Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院疼痛科,北京100053

出　　处：《首都医科大学学报》2020年第2期272-276,共5页Journal of Capital Medical University

摘　　要：目的回顾性分析影像引导下蝶腭神经节及颈神经阻滞对于顽固性蝶腭神经痛(sphenopalatine neuralgia,SPN)的治疗效果。方法对22例蝶腭神经痛患者,行C型臂或电子计算机断层扫描(computed tomography,CT)定位侧入路穿刺行蝶腭神经阻滞及超声引导颈2-颈5颈神经阻滞和颈椎关节突关节注射治疗(1~3次,每周1次)。随访时间2~64个月,平均(38.86±16.08)个月,记录术后24 h、1个月、3个月、6个月、1年、2年、3年时数字量表(numerical rating scale,NRS)评分,评价治疗效果并观察治疗后不良反应(包括面部血肿、视力障碍、颅内感染、体位性血压等)发生情况。结果术后24 h、1个月、3个月、6个月、1年、2年、3年,NRS评分较术前显著降低(P<0.01),治疗有效率分别为95.45%(21/22)、90.9%(20/22)、95.24%(20/21)、95.24%(20/21)、100%(20/20)、100%(19/19)、100%(17/17),术后2例(9.09%)患者出现轻度血肿,经过24 h冰敷后完全消退,未发生其他不良反应。结论C-型臂X线或CT引导蝶腭神经阻滞联合颈椎旁及关节突关节注射是治疗顽固性蝶腭神经痛的一种安全、有效、持续时间长、患者乐于接受的微创治疗方法。Objective To retrospectively analysis the therapeutic effect for viable sphenopalatine neuralgia(SPN)by image-guided(C-arm or CT-guided)sphenopalatine ganglion block combined with selective cervical paravertebral nerve block and cervical joint injection.Methods Totally 22 patients with sphenopalatine neuralgia underwent C-arm guided sphenopalatine ganglion block combined with ultrasound-guided nerve block of cervical 2-5 and cervical joint injection(1-3times,once a week).Numeric rating scales(NRS)was obtained at 24 hours,1 month,3 months,6 months,1 year,2 years,and 3 years after nerve block.The telephone follow-up lasted for 3-64 months,with average of(38.86±16.08)months.The therapeutic efficacy was evaluated,and the post-therapy adverse reaction was recorded.Results NRS scores significantly decreased after treatment at 24 hours,1 month,3 months,6 months 1 year,2 years and 3 years.The effective rate after procedure was 95.45%(21/22),90.9%(20/22),95.24%(20/21),95.24%(20/21),100%(20/20),100%(19/19),100%(17/17)at 24 hours,1 month,3 months,6 months 1 year,2 years and 3 years,respectively.Two(9.09%)patients presented with mild facial hematoma,which were completely relieved after ice compresses applied for 24 hours.No other adverse reaction was found.Conclusion C-arm or CT-guided sphenopalatine ganglion block combined with ultrasound-guided cervical paravertebral nerve block and cervical joint injection for viable SPN could relieve the pain completely,which could last for long time.It is a safe,effective,and stable mini-invasive therapy.

关 键 词：蝶腭神经痛 蝶腭神经节 神经阻滞 超声引导 颈椎旁 颈椎关节突关节 

分 类 号：R614.4[医药卫生—麻醉学]