超声引导下颈5交感神经节阻滞治疗继发性嗅觉缺失患者的疗效分析  

Efficacy of ultrasound-guided C5 sympathetic ganglion block for the treatment of patients with secondary anosmia

作　　者：徐池 孙瑶 钱佳栋 陆雅萍 费勇 姚明 黄冰 叶玲玉 Xu Chi;Sun Yao;Qian Jiadong;Lu Yaping;Fei Yong;Yao Ming;Huang Bing;Ye Lingyu(Medical Center for Anesthesiology and Pain,the First Hospital of Jiaxing and the Affiliated Hospital of Jiaxing University,Jiaxing City,Zhejiang Province 314000,China;Zhejiang Chinese Medical University,Hangzhou City,Zhejiang Province 310053,China;Department of Otolaryngology,the First Hospital of Jiaxing and the Affiliated Hospital of Jiaxing University,Jiaxing City,Zhejiang Province 314000,China;Department of Neurosurgery,the First Hospital of Jiaxing and 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314000 [2]浙江中医药大学,杭州市310053 [3]嘉兴市第一医院/嘉兴学院附属医院耳鼻咽喉科,浙江省314000 [4]嘉兴市第一医院/嘉兴学院附属医院神经外科,浙江省314000

出　　处：《中华疼痛学杂志》2021年第5期503-509,共7页Chinese Journal Of Painology

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

摘　　要：目的探讨超声引导下穿刺行颈5交感神经节阻滞治疗继发性嗅觉缺失患者的有效性与安全性。方法本研究前瞻性收集2017年1月至2021年1月嘉兴市第一医院耳鼻咽喉科诊断为嗅觉缺失经常规保守治疗2个月无效转入疼痛科治疗患者33例,行超声引导下穿刺行颈5交感神经节阻滞(CSGB)注入治疗药液10 ml,注射后超声监测药液扩散距离(DD)、颈椎长度(CL)及DD占CL的百分比;记录治疗前(T0)、注药完毕即时(T1)、治疗后10 min时(T2)、治疗后1周时(T3)患者平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO_(2))变化、不良反应及并发症发生情况;观察不同病程、不同年龄段治疗后嗅觉功能的恢复程度,及T0、T3时点嗅觉功能评分比较。结果本研究33例患者治疗前嗅觉功能评分均为0分,T3时嗅觉功能评分为(2.0±0.9)分,有效率为87.9%(29/33例),与T0时比较差异有统计学意义(P<0.05)。T3时优效、良效、可效、无效分别为10、18、1和4例。DD/CL值与T3嗅觉功能评分无显著相关性(r=0.154,P=0.392);病程≤1年患者治疗有效率为100.0%(20/20例),病程>1年者治疗有效率69.2%(9/13例),两者比较差异有统计学意义(P<0.05);患者年龄≤50岁患者治疗有效率84.2%(16/19例),年龄>50岁患者治疗有效率92.8%(13/14例),两者比较差异无统计学意义(P>0.05)。与T0比较,MAP、HR在T1时升高,差异均有统计学意义(P均<0.05)。本组33例患者CSGB后出现声音嘶哑8例(24.2%),未见臂丛神经阻滞导致的手麻、上肢无力,无呼吸困难、气胸、局部血肿、局麻药中毒等不良反应及并发症发生。结论采用超声引导下C_(5)水平颈交感神经节阻滞治疗继发性嗅觉缺失安全有效。Objective To investigate the efficacy and safety of ultrasound-guided C5 cervical sympathetic ganglion block for the treatment of patients with secondary anosmia.Methods In this prospective study,33 patients with secondary anosmia in the Otolaryngology Department of the First Hospital of Jiaxing City,from January 2017 to January 2021 failed to conventional treatment for two months were transferred to the Department of Painology.C5 sympathetic ganglion block(CSGB)was performed with 10 ml therapeutic solution under the ultrasound guidance.After the injection,liquid diffusion distance(DD),cervical spine length(CL)and calculation of the percentage of DD in CL were measured with ultrasound image.MAP,HR and SpO_(2)were observed before the treatment(T0),after the injection immediately(T1),at 10 minutes(T2)and 1 week after the treatment(T3).Adverse reactions and complications were also observed.The effects of patients'different diseased course and age stage on the recovery of olfactory function were observed after the treatment,and the scores of olfactory function at T0 and T3 were compared.Results The olfaction score were 0 in the 33 patients before the treatment.The olfaction score was recovered to(2.0±0.9)and the effective rate was 87.9%(29/33 cases)at T3(P<0.05).The cases of excellent,good,poor effects and invalid were 10,18,1 and 4 at T3 respectively.DD/CL had no significant correlation with T3 olfactory function score(r=0.154,P=0.392).The effective rate was 100.0%(20/20 cases)in patients with diseased course≤1 year and 69.2%(9/13 cases)in patients with diseased course>1 year(P<0.05).The effective rate was 84.2%(16/19 cases)for patients aged≤50 years old,and 92.8%(13/14 cases)for patients aged>50 years old,with no statistical significance(P>0.05).Compared with T0,MAP and HR were higher at T1(P<0.05).Hoarseness occurred in 8 cases after CSGB(24.2%),no hand numbness,upper limb weakness,dyspnea,pneumothorax,local hematoma,and local anesthetic intoxication.Conclusion Ultrasound-guided C_(5)cervical sympathetic gang

关 键 词：神经阻滞 颈 交感神经 颈椎骨 嗅觉缺失 

分 类 号：R765.61[医药卫生—耳鼻咽喉科]