超声引导下膈神经联合星状神经节阻滞治疗顽固性呃逆的短期疗效及安全性

Short-term efficacy and safety of ultrasound-guided phrenic nerve block combined with stellate ganglion block for patients with intractable hiccups

目的观察超声引导下膈神经联合星状神经节阻滞治疗顽固性呃逆患者的短期临床疗效及安全性。方法本研究为回顾性研究。收集2020年11月1日至2023年12月31日于天津市人民医院疼痛科门诊就诊及住院会诊的顽固性呃逆患者18例,病程≥1个月,年龄、性别不限,所有患者经常规治疗无效后,均采用超声引导下膈神经联合星状神经节阻滞治疗(采用高频线阵超声探头,不能明确侧别者优先行左侧膈神经和星状神经节阻滞),分别注射1%利多卡因3 ml,若阻滞后呃逆消失则停止治疗,否则1次/d,双侧交替,最多4次。记录治疗前及治疗后1、2、4周的呃逆症状评分及精神状态和睡眠质量评分,并记录治疗4周后的有效率、不良反应及并发症。采用SPSS 22.0统计软件进行统计分析。结果治疗后各时点的呃逆症状评分均较治疗前明显降低[0(0,3)、0(0,3)、0(0,3)比6(6,9),P均<0.05],精神状态评分和睡眠质量评分均较治疗前明显升高[4(4,5)、5(4,5)、5(4,5)比2(2,3),4(4,5)、5(4,5)、4(4,5)比3(2,3),P均<0.05],但治疗后各时点比较差异均无统计学意义(P均>0.05)。治疗后4周的总有效率为88.9%(16/18例),所有患者均未见不良反应及并发症。结论超声引导下膈神经联合星状神经节阻滞是治疗顽固性呃逆安全、短期有效的方法。

Objective To observe the short-term efficacy and safety of ultrasound-guided phrenic nerve block combined with stellate ganglion block in the treatment of patients with intractable hiccups.Methods This study was a retrospective study.A total of 18 patients with intractable hiccups,duration≥1 month,regardless of age or gender,were retrospectively studied in the Department of Pain Medicine,Tianjin People's Hospital from November 1,2020 to December 3,2023.All patients had ineffective conventional therapy,and were treated with 1%lidocaine 3 ml respectively by ultrasound-guided phrenic nerve combined with stellate ganglion block(a high-frequency linear array ultrasound probe,priority to the left phrenic nerve and stellate ganglion block).If the hiccup disappeared after the nerve block,the treatment was finished,otherwise,once a day,alternating sides,up to 4 times.The hiccup symptoms score,mental state score and sleep quality score were recorded before the treatment and 1,2 and 4 weeks after the treatment.The effective rate,adverse reactions and complications were recorded after 4 weeks of the treatment.SPSS 22.0 software was used for statistic analysis.Results At each time point after the treatment,the hiccup symptoms score was significantly lower[0(0,3),0(0,3),0(0,3)vs.6(6,9),all P<0.05].Mental status score and sleep quality score were significantly higher than those before the treatment[4(4,5),5(4,5),5(4,5)vs.2(2,3);4(4,5),5(4,5),4(4,5)vs.3(2,3);all P<0.05],but no significant difference among each time point.The total effective rate was 88.9%(16/18 cases)after 4 weeks of the treatment(all P>0.05),and no adverse reactions and complications were observed in all patients.Conclusion Ultrasound-guided phrenic nerve block combined with stellate ganglion block is a safe and short-term effective method for patients with intractable hiccups.