CAJ | 학술논문

目的观察CT引导下胸、腰交感神经联合阻滞治疗手、足多汗症的临床效果. 方法浙江省嘉兴市第一医院疼痛医学科自2013年1月至2014年12月采用CT引导下胸、腰交感神经联合阻滞治疗手、足多汗症23例,穿刺点为T3～4、2～3椎间隙,分别抵达T4肋骨小头上方、L3椎体前外侧与腰大肌前方,胸、腰交感神经旁分别注入含造影剂碘海醇的10g/L利多卡因2mL、3mL,CT扫描胸、腰段所注药液分别分布在T4肋骨小头前方、腰大肌与椎体之间,患者手指、脚趾末梢灌注指数(PI)上升5倍以上和双手、脚掌温度上升3℃以上时,再分别注入含造影剂碘海醇的无水乙醇3 mL、5mL.比较患者注药前后各生理指标的变化并判定疗效. 结果 23例患者均在CT定位穿刺引导器的引导下穿刺至各个靶点.与用药前比较,用局麻药后5min、用无水乙醇后5min患者食指、脚趾的PI和双手掌、足掌温度均增加,但用无水乙醇后5 min患者食指、脚趾的PI和双手掌、足掌温度低于用局麻药后5 min时,差异均有统计学意义(P＜0.05).术后随访1年内患者效果优良21例(86.96％),复发3例(13.04％). 结论 CT引导下胸、腰交感神经联合阻滞技术可有效治疗手、足多汗症.
목적 관찰CT인도하흉、요교감신경연합조체치료수、족다한증적림상효과. 방법 절강성가흥시제일의원동통의학과자2013년1월지2014년12월채용CT인도하흉、요교감신경연합조체치료수、족다한증23례,천자점위T3～4、2～3추간극,분별저체T4륵골소두상방、L3추체전외측여요대기전방,흉、요교감신경방분별주입함조영제전해순적10g/L리다잡인2mL、3mL,CT소묘흉、요단소주약액분별분포재T4륵골소두전방、요대기여추체지간,환자수지、각지말소관주지수(PI)상승5배이상화쌍수、각장온도상승3℃이상시,재분별주입함조영제전해순적무수을순3 mL、5mL.비교환자주약전후각생리지표적변화병판정료효. 결과 23례환자균재CT정위천자인도기적인도하천자지각개파점.여용약전비교,용국마약후5min、용무수을순후5min환자식지、각지적PI화쌍수장、족장온도균증가,단용무수을순후5 min환자식지、각지적PI화쌍수장、족장온도저우용국마약후5 min시,차이균유통계학의의(P＜0.05).술후수방1년내환자효과우량21례(86.96％),복발3례(13.04％). 결론 CT인도하흉、요교감신경연합조체기술가유효치료수、족다한증.
Objective To evaluate the clinical effects of CT guided thoracic sympathetic nerve block combined with lumbar sympathetic nerve block on palmar and plantar hyperhidrosis.Methods Twenty-three patients with palmar and plantar hyperhidrosis, received combined thoracic and lumbar sympathetic nerve blocks in our hospital from January 2013 to December 2014, were chosen.Under CT guidance, thorocic intervertebral puncture was performed between T3 and T4 till the needle tip reached the spot around T4 and above capitis costae;lumbar intervertebral puncture was performed between L2 and L3 till the needle tip reached the lateral side of L3 and the anterior side of the psoas muscle.Two mL and 3 mL 1％ lidocaine containing contrast agent iohexol were injected adjacently to thoracic and lumbar sympathetic nerves, respectively.The injected liquid was observed to be distributed in front of T4 capitis costae, or between the psoas muscle and the verterbrae of L3.The patient's finger and toe tip perfusion index (PI) was elevated more than 5 folds;the temperature of hands and feet increased more than 3 ℃.Then, the patients received 3 mL and 5 mL anhydrous alcohol (containing iohexol), respectively, at thoracic and lumbar puncture points for CT scanning and three-dimensional reconstruction of the physic liquor distribution.Results CT could precisely guide the puncture needle to reach the target in these 23 patients.As compared with those before medication, the finger and toe tips perfusion indexes and temperatures of palmar and plantar surfaces at 5 min after injection of local anesthetics and 5 min after anhydrous alcohol were significantly increased (P＜0.05);significant differences of them were noted between injections of local anesthetics and anhydrous alcohol (8.03±1.44 vs.4.94±1.65, 33.35±1.79 vs.32.94±1.54, P＜0.05).One year after follow up, the rate of excellent and good therapeutic effects was 86.96％ (n=21);and 1-year recurrence rate was 13.04％ (n=3) without any complications.Conclusion CT guided thoracic combined with lumbar sympathetic nerve block technique is effective in treating palmar and plantar hyperhidrosis.