不同浓度罗哌卡因星状神经节阻滞对颈源性头痛的药效时间观察

Observation of the efficacy time with different concentrations of ropivacaine SGB treatment for cervicogenic headache

目的探讨颈源性头痛(CEH)患者在不同浓度罗哌卡因星状神经节阻滞(SGB)治疗时的药效时间。方法收集上海交通大学附属第六人民医院疼痛科2019年3月至2020年3月CEH患者60例,采取随机数字表法将患者分为A、B、C 3组(n=20),罗哌卡因浓度分别为0.1%、0.2%、0.3%,每组均用5 ml。3组患者均采用超声引导下SGB的方法进行治疗,以出现同侧霍纳综合征作为阻滞成功标志。观察各组阻滞起效时间、维持时间、治疗前及治疗1 h后心率改变,治疗前及治疗1周后McGill疼痛量表评分、视觉模拟评分(VAS)、现有疼痛强度(PPI)变化,并发症发生情况和临床满意度比较。结果阻滞起效时间A组(4.8±2.1)min较其他两组慢(P<0.05),阻滞维持时间C组(329±68)min较其他组长(P<0.05),A组(147±60)min阻滞维持时间最短(P<0.05)。治疗前后HR变化差异无统计学意义(P>0.05)。治疗前3组患者PRI、VAS评分、PPI差异无统计学意义(P>0.05)。治疗后1周A组PRI(9.2±1.7),VAS评分(4.4±0.7)分及PPI(2.5±0.5)分,均较其他组高(P均<0.05)。C组25%(5/20例)不良反应发生情况高于其他两组,B组95%(19/20例)的治疗满意度高于其他两组,差异有统计学意义(P<0.05)。结论超声引导下对CEH进行SGB治疗时使用0.2%罗哌卡因,不良反应少、治疗效果佳、满意度最好,临床使用适宜。

Objective To explore the efficacy time with different concentrations of ropivacaine stellate ganglion block(SGB)for patients with cervicogenic headache(CEH).Methods Sixty patients with CEH,in the Department of Painology,Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from March 2019 to March 2020,were collected.The patients were randomly divided into A,B and C groups by random number table method(n=20).SGB was performed by ropivacaine 5 ml in different concentration of 0.1%,0.2%,or 0.3%respectively,under ultrasound guidance,and ipsilateral Horner's syndrome as a criterion for the block success.The onset time,maintenance time,changes of heart rate(HR)before the block and 1 h after the block,changes of McGill Pain Scale scores and visual analogue scale(VAS),present pain intensity(PPI)before the block and 1 week after the block,and the occurrence of adverse reactions were observed in each group.Results The onset time of block was slower in the group A(4.8±2.1)min than that in the other two groups(P<0.05);the block maintenance time was longer in the group C(329±68)min than that in the other groups(P<0.05),and was the shortest in the group A(147±60)min(P<0.05).There was no significant change in HR before and after the block(P>0.05).The pain rating index(PRI),VAS and PPI had no significant differences among the three groups(P>0.05).After 1 week of the SGB,PRI(9.2±1.7),VAS(4.4±0.7)and PPI(2.5±0.5)were higher in the group A than those in other groups(P<0.05).The adverse reactions were higher in the group C(25%,5/20 cases)than those in other two groups,and the treatment satisfaction was higher in the group B(95%,19/20 cases)than the other two groups(P<0.05).Conclusion SGB with 0.2%ropivacaine for treatment of CEH under ultrasound guidance has a good efficacy,best satisfaction,with few adverse reactions.