CT引导下行胸交感神经链化学毁损性阻滞治疗时并发气胸的预防

Prevention of pneumothorax in CT-guided thoracic sympathetic nerve block

目的探讨CT引导下采用胸交感神经阻滞穿刺针、按安全距离和只进不退的穿刺技术,行胸交感神经链化学毁损性阻滞治疗对气胸并发症发生的预防作用。方法回顾分析2010年1月至2017年12月嘉兴市第一医院麻醉与疼痛医学中心行CT引导下胸交感神经链化学毁损性阻滞治疗769例多汗症和雷诺综合征患者的临床资料。穿刺方法为CT引导下设计穿刺路径、采用胸交感神经阻滞穿刺针(尖端65°钝头)按"安全距离"和"只进不退"的操作原则穿刺至肋骨小头上方的壁胸膜外,穿刺成功后通过CT肺窗观察有无气胸发生,确认无气胸发生后两侧各注入无水乙醇2.5 ml(含30%碘海醇注射液0.25 ml)行阻滞治疗。结果769例患者(1538侧神经链节段)均穿刺成功,CT肺窗观察均无气胸发生。注入无水乙醇阻滞治疗后,31例出现霍纳综合征,经向该侧星状神经节注射生理盐水后霍纳综合征消失;术后出现相应节段肋间神经痛者188例,均于1~3个月自愈。结论胸交感神经链阻滞穿刺时,通过采取CT引导、改进穿刺针具和相应的穿刺技巧可避免气胸的发生。

Objective To explore the measures for prevention of pneumothorax in CT-guided thoracic sympathetic block.Methods The clinical data of 769 patients with hyperhidrosis or Raynaud syndrome treated with CT-guided chemical destructive block of thoracic sympathetic nerve chain in Jiaxing First Hospital from January 2010 to December 2017 were retrospective analyzed.The CT-guided thoracic sympathetic nerve block puncture was performed with a special blunt needle outside the wall pleura above the caput costae following the principle of"safe distance"and"advance only".After exclusion of pneumothorax by CT scan,2.5 ml of absolute ethanol mixed with 30%iohexol 0.25 ml was injected on both sides of thoracic sympathetic nerve chain.Results The punctures were successfully performed in all 769 patients(1538 nerve chain segments)and no pneumothorax occurred.After treatment with absolute ethanol injection,Horner syndrome occurred in 31 patients,which disappeared after injecting saline into the stellate ganglion;and intercostal neuralgia occurred in 188 patients after surgery,which was healed in 1 to 3 months.Conclusion It is suggested that pneumothorax can be avoided through CT guidance,using appropriate needles and puncture techniques during the procedure of thoracic sympathetic nerve chain block.