CT引导下经皮穿刺茎乳孔射频脉冲治疗Ramsay-Hunt综合征案例分析1例  

CT-guided percutaneous puncture of the styroemulsion foramen and radiofrequency pulse in the treatment of Ramsay-Hunt syndrome:a case study

作　　者：李娟娟[1] 芦胜胜 王晓英[1] 雷晴宇 LI Juanjuan;LU Shengsheng;WANG Xiaoying;LEI Qingyu(Department of Pain,Jiujiang First People's Hospital,Jiujiang,Jiangxi,332000,China)

机构地区：[1]九江市第一人民医院疼痛科,江西九江332000

出　　处：《当代医学》2024年第19期12-16,共5页Contemporary Medicine

摘　　要：患者,男,57岁,因咳嗽、咳痰1周入院。入院诊断考虑上呼吸感染,予以抗感染治疗后上呼吸道感染症状好转。但在入院第3天患者右侧口腔、颜面部、耳部出现大面积疱疹,部分伴有小脓疱,并且右侧颜面部皮损区域疼痛难忍,影响睡眠,视觉模拟评分法(visual analogue scale,VAS)评分8分。经多学科会诊后,诊断为Ramsay-Hunt综合征。按照House-Brackmann分级患者处于Ⅳ级,予以抗病毒、消炎止痛等治疗后,疱疹消退,皮损愈合,但疼痛程度无好转,并出现右侧面瘫,表现为右侧额纹消失、皱眉不能、闭目不全、鼻唇沟变浅、鼓腮漏气、口角偏向健侧等症状,伴有右耳耳鸣、听力下降。调整治疗方案,予以针灸及星状神经节阻滞治疗后,患者疼痛减轻,VAS评分2分,听力好转,但面瘫、耳鸣症状仍存在。在CT引导下经茎乳孔射频脉冲治疗,患者面瘫、耳鸣症状好转,VAS评分0分,House-Brackmann分级为Ⅰ级。The patient,a 57-year-old male,was admitted to hospital with cough and sputum for 1 week.The admission diagnosis was considered:upper respiratory infection,and the symptoms of upper respiratory tract infection improved after anti-infective treatment.However,on the third day of admission,the patient developed a large herpes on the right side of the mouth,face and ear,partly accompanied by small pustules,and the area of the lesion on the right side of the face was painful and interfered with his sleep,with a visual analogue scale(VAS)score of 8 scores.After a multidisciplinary treatment,a diagnosis of Ramsay-Hunt syndrome was made.The patient was in classⅣaccording to the House-Brackmann scale,after treatment with antiviral,anti-inflammatory and analgesic therapy,the herpes subsided and the lesions healed,but the pain level did not improve and the patient developed right-sided facial palsy,which was manifested by loss of right frontal lines,inability to frown,incomplete eye closure,shallow nasolabial folds,cheek puffing and air leakage,and a deviation of the corners of the mouth to the healthy side,accompanied by tinnitus in the right ear and hearing loss.After adjusting the treatment plan,the patient was treated with acupuncture and stellate ganglion block,the pain was reduced and the VAS score was 2 scores and the hearing improved,but the symptoms of facial paralysis and tinnitus still existed.After CT-guided radiofre-quency pulse therapy through stylomastoid foramen,the symptoms of facial paralysis and tinnitus were improved,the VAS score was 0 score,and the House-Brackmann scale was gradeⅠ.

关 键 词：RAMSAY-HUNT综合征 面瘫 射频脉冲 针灸 

分 类 号：R59[医药卫生—内科学]