CT引导下腰交感神经化学毁损性阻滞治疗肢体冷感症的疗效观察

Observation on the efficacy of CT-guided lumbar sympathetic chemical destructive block in the treatment of cold sensation of limbs

目的观察CT引导下腰交感神经化学毁损性阻滞治疗肢体冷感症的临床效果。方法回顾性分析嘉兴学院附属医院2015年1月至2018年1月43例采用腰交感神经化学毁损性阻滞治疗肢体冷感症患者的临床资料,记录并分析治疗前和注入无水乙醇后5 min患者心率、无创血压(NIBP)、足趾血氧饱和度(SpO2)、脚掌温度和末梢灌注指数(PI)的变化。并于术后1 d、1周、1个月、3个月、6个月、1年和2年进行随访。结果43例患者均在CT引导下行双侧腰交感神经化学毁损性阻滞,所有患者均顺利穿刺至靶点。治疗前及治疗后患者PI分别为1.2±0.6、7.2±3.0,治疗后显著上升,差异有统计学意义(t=12.386,P<0.05);治疗前及治疗后患者脚掌温度分别为(29.6±1.7)、(34.6±1.1)℃,治疗后显著上升,差异有统计学意义(t=15.057,P<0.05);治疗后患者心率、NIBP、SpO2与治疗前相比差异均无统计学意义(均P>0.05)。39例(90.7%)患者腰交感神经毁损性阻滞临床有效,4例(9.3%)患者无效。39例临床有效的患者中,29例患者疗效达到优良,10例患者疗效达到改善。术后复发者10例(25.6%)。患者术后1 d、1周、1个月、3个月、6个月、1年和2年的满意度分别为93.0%、90.7%、86.0%、76.7%、69.7%、65.1%和53.4%。结论腰交感神经化学毁损性阻滞是治疗肢体冷感症的一种安全有效的治疗方式,在一定程度上可以改善患者肢体冷感症状。

Objective To observe the clinical effects of CT-guided chemical destructive block of lumbar sympathetic nerve in the treatment of cold sensation of limbs.Methods In this retrospective analysis,clinical data of 43 patients with cold sensation of limbs treated by lumbar sympathetic chemical destructive block in the Affiliated Hospital of Jiaxing University from January 2015 to January 2018 were collected.The changes of heart rate,non-invasive blood pressure(NIBP),oxygen saturation(SpO2),plantar temperature and peripheral perfusion index(PI)of patients were recorded and analyzed before treatment and 5 min after injection of anhydrous ethanol.The patients were followed up at postoperative 1 day,1 week,1 month,3 months,6 months,1 year and 2 years.Results Fourty-three patients underwent bilateral lumbar sympathetic nerve chemical destructive block under the CT-guided,and all patients were punctured to the target successfully.The PI of patients before and after treatment were 1.2±0.6,7.2±3.0 respectively,which was significantly increased after treatment compared with before treatment,and the difference was statistically significant(t=12.386,P<0.05).The plantar temperature of patients before and after treatment respectively were(29.6±1.7)℃,(34.6±1.1)℃,which was significantly increased after treatment compared with before treatment,and the difference was statistically significant(t=15.057,P<0.05).There were no significant differences in heart rate,NIBP and SpO2 between before and after treatment(all P>0.05).Lumbar sympathetic chemical destructive block was clinically effective in 39 patients(90.7%)and ineffective in 4 patients(9.3%).Among the 39 clinically effective patients,the curative effects were excellent in 29 cases and improved in 10 cases.Postoperative recurrence occurred in 10 cases(25.6%).The satisfaction rates of patients at 1 day,1 week,1 month,3 months,6 months,1 year and 2 years after operation were 93.0%,90.7%,86.0%,76.7%,69.7%,65.1%and 53.4%,respectively.Conclusion Lumbar sympathetic chemical destructive block is a safe and effective way for the treatment of cold sensation of limbs,which can improve the symptoms of cold sensation of limbs to some extent.