脉搏氧灌注指数结合鼻翼温度用于评价颈交感神经阻滞治疗嗅觉丧失患者的效果  

Evaluating the effects of cervical sympathetic ganglia block with oxygen perfusion index and alar temperature during the treatment of patients with anosmia

作　　者：陆雅萍 费勇 谢可越 钱佳栋 孙瑶 黄冰 姚明 Lu Yaping;Fei Yong;Xie Keyue;Qian Jiadong;Sun Yao;Huang Bing;Yao Ming(Medical Center for Anesthesiology and Pain,the First Hospital of Jiaxing/the Affiliated Hospital of Jiaxing University,Jiaxing City,Zhejiang Province 314000,China;Department of Neurosurgery,the First Hospital of Jiaxing/the Affiliated Hospital of Jiaxing University,Jiaxing City,Zhejiang Province 314000,China;Department of Otolaryngology,the First Hospital of Jiaxing/the Affiliated Hospital of Jiaxing University,Jiaxing City,Zhejiang Province 314000,China)

机构地区：[1]嘉兴市第一医院/嘉兴学院附属医院麻醉与疼痛医学中心,浙江省嘉兴市314000 [2]嘉兴市第一医院/嘉兴学院附属医院神经外科,浙江省嘉兴市314000 [3]嘉兴市第一医院/嘉兴学院附属医院耳鼻咽喉科,浙江省嘉兴市314000

出　　处：《中华疼痛学杂志》2020年第6期507-512,共6页Chinese Journal Of Painology

基　　金：浙江省医药卫生科技计划项目(2019KY213);嘉兴市医学重点学科建设计划-麻醉学(2019-ZC-06)。

摘　　要：目的探讨监测脉搏氧灌注指数(PI)结合鼻翼温度(AT)评价颈交感神经阻滞(CSGB)治疗嗅觉丧失患者效果的临床意义。方法前瞻性收集2015年11月至2019年6月嘉兴市第一医院耳鼻咽喉科诊断为嗅觉丧失患者,转入疼痛科行超声引导下CSGB治疗54例性别不限,年龄18~75岁,监测治疗前(T0)、治疗后10 min(T1)、治疗后1周(T2)时患者,治疗侧PI、同侧AT,记录PI、AT在T0~T1的差值绝对值ΔPI和ΔAT,同时观察治疗期间患者平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO2)变化,有无不良反应及并发症,有无出现Horner综合征等现象。结果本研究纳入的54例嗅觉功能评分0分患者中,T2时嗅觉功能评分为(2.2±1.0)分,有效率为87.0%(47/54例),男女患者有效率比较、各原发病有效率比较差异均无统计学意义(P值分别为0.124、0.154)。MAP、HR、SpO2在3个时点比较差异均无统计学意义(P值分别为0.217、0.955、0.981)。PI、AT 3个时点比较差异均有统计学意义(P均<0.05),在时点T1、T2分别与T0比较,两者差异均有统计学意义(P均<0.05)。患者T2时嗅觉功能评分与ΔPI的直线相关系数r=0.587,差异有统计学意义(P<0.001);与ΔAT的直线相关系数r=0.036,差异无统计学意义(P=0.795)。本组54例患者CSGB后有42例(77.8%)出现了Horner综合征,声音嘶哑13例(24.1%),未见臂丛神经阻滞导致的手麻、上肢无力,未见膈神经阻滞导致的呼吸困难,未见气胸、局部血肿、局麻药中毒等不良反应及并发症发生。结论脉搏氧灌注指数、鼻翼温度可以有效评价临床CSGB治疗嗅觉丧失患者的疗效。Objective To explore the clinical significance of oxygen perfusion index(PI)combined with alar temperature(AT)in evaluating the effect of cervical sympathetic ganglion block(CSGB)during the treatment of patients with anosmia.Methods Fifty-four patients diagnosed with anosmia,after various ineffective treatments,both sexes,aged 18-75 years old,were transferred from Otolaryngology Department of Jiaxing First Hospital to the Pain Department,for ultrasound guided cervical sympathetic block from November 2015 to June 2019.PI and AT were observed before the treatment(T0),and 10 min(T1)and 1 week(T2)after the treatment.ΔPI andΔAT were recorded at T0 and T1.The changes of mean arterial pressure(MAP),heart rate(HR)and pulse oxygen saturation(SpO2)were recorded.Adverse reactions and complications including Horner's syndrome were recorded.Results After 1 week of the treatment,the olfaction score was(2.2±1.0),and the effective rate was 87.0%(47/54 cases)in these 54 patients with no olfaction.There was no significant difference in the effective rate between male and female patients and in primary diseases(P was 0.124 and 0.154,respectively),and so did in MAP,HR and SpO2 at three time points(P was 0.217,0.955 and 0.981,respectively).There were statistical differences among the three time points of PI or AT(all P<0.05).AT T1 and T2,the differences of PI and AT were statistically different compared with T0 respectively(all P<0.05).The linear correlation coefficient between olfactory score andΔPI at T2 was 0.587(P<0.001);the linear correlation coefficient between olfactory score andΔAT was 0.036(P=0.795).Forty-two patients(77.8%)appeared Horner syndrome and 13 patients(24.1%)occurred hoarseness after the CSGB.No brachial plexus block,phrenic block,pneumothorax,local hematoma,local anesthetic poisoning and other adverse reactions happened.Conclusion Oxygen PI and AT could evaluate the clinical effects of CSGB during the treatment of patients with anosmia.

关 键 词：嗅觉障碍 神经传导阻滞 神经节 交感神经 灌注指数 鼻翼温度 

分 类 号：R765.61[医药卫生—耳鼻咽喉科]