星状神经节阻滞对复杂性区域疼痛综合征发病率影响的研究

Study on the incidence of complex regional pain syndrome after the upper extremity surgery with brachial plexus anesthesia and stellate ganglion block

关键词:  星状神经节阻滞  复杂性区域疼痛综合征  发病率  罗哌卡因  利多卡因

Key words:  [Key words] 　SGB  CRPS  incidence  ropivacaine  lidocaine

摘要:

目的　观察在上肢手术中进行臂丛神经阻滞的患者合并行星状神经节阻滞（SGB）后对复杂性区域疼痛综合征(CRPS)的发病率的影响。方法　选择140例ASAⅠ～Ⅱ级的行上肢臂丛神经阻滞手术的患者，随机分为两组，每组70例，A组（试验组）为星状神经节阻滞（SGB）组，B组（对照组）为非星状神经节阻滞组。A组患者手术开始前行臂丛神经合并星状神经节阻滞，待出现霍纳氏征并且手术区域感觉及运动阻滞效果均完善后开始手术。B组患者行单纯臂丛神经阻滞，待手术区域感觉及运动阻滞效果均完善，但没有霍纳氏综合征出现后开始手术。所有患者均用局麻药:0.33%罗哌卡因+1.33%利多卡因30 mL混合液行臂丛阻滞，术中均异丙酚镇静。术后患者行3个月随访，观察比较A、B两组复杂性区域疼痛综合征（CRPS）的发病情况。复杂性区域疼痛综合征（CRPS）的诊断标准以2007年国际疼痛研究会（IASP）修订的诊断标准为依据。结果　3个月观察结果对比，A组仅2例出现CRPS，总发病率为2.85%；而B组12例，总发病率为17.14%。Ａ组CRPS发病率低于Ｂ组，差异有显著性意义（P<0.05）。结论　对上肢手术患者进行星状神经节阻滞可以大大降低复杂性区域疼痛综合征的发病率，可以明显降低患者术后肢体功能障碍的发生，提高患者的生活质量，节约医疗成本。

Abstract:

[Abstract] Objective　To study the incidence rates of complex regional pain after a comprehensive summary (CRPS) in the upper extremity surgery using brachial plexus block and stellate ganglion block (SGB). Methods　Totally, 140 cases (ASA classⅠ－Ⅱ) who received upper extremity surgery were randomly divided into two groups (A group 70cases, B group 70 cases). In anesthesia procedures, the A group were treated with brachial plexus block and stellate ganglion block (SGB), whereas B group with brachial plexus block only. Surgery was started in A group after Horner syndrome occurred and good anesthetic effect of sensorimotor in the surgical area was obtained. However, surgery was started in B group without occurrence of Horner syndrome. Both groups of patients received local anesthetics: 0.33% ropivacaine + 1.33% lidocaine 30 mL. We followed up these cases for 3-month and compared the incidence of complex regional pain syndrome (CRPS) between A and B groups. The diagnostic criteria of CRPS followed International Association for the Study of Pain (IASP, 2007) . Results　The number of CRPS in Group A was 2 cases with an overall incidence of 2.85% in 3 months; while the number of CRPS in Group B was 12 with an overall incidence of 17.14%. There was significant difference between group A and B (P<0.05).Conclusion　Treatment with brachial plexus block and stellate ganglion block (SGB) is helpful to reduce the incidence of CRPS and improve limb physical function and quality of life.