摘要
目的:评价超声引导下头半棘肌平面(SCP)阻滞治疗枕神经痛(ON)的效果。方法:本研究为前瞻性研究。选取2022年1月至2023年12月就诊于淄博市市立医院的ON患者90例,性别不限,年龄29~66岁,病程3个月~6年,采用随机数字表法分为3组(n=30):枕大神经(GON)阻滞联合第3枕神经(TON)阻滞组(GT组)、SCP的头半棘肌内侧头(SCM-m)肌腹内阻滞组(Sm组)和SCP的头下斜肌-颈2,3小关节(OCI-C_(2,3))间隙阻滞组(OC组)。GT组分别于项区C_(2)水平SCM-OCI间隙内GON周围和C_(2,3)侧面浅方各注射镇痛抗炎复合液2.5 ml;Sm组于项区C 1水平SCM-m肌腹内注射镇痛抗炎复合液5 ml;OC组于项区SCM深方OCI-C_(2,3)间隙内注射镇痛抗炎复合液5 ml。分别于治疗前(T_(1))和治疗后1、3、7、10、14 d(T_(2-6))时记录疼痛视觉模拟量表(VAS)评分和匹兹堡睡眠质量指数(PSQI)评分,计算疼痛缓解率和睡眠质量改善率。记录阻滞操作时间、阻滞起效时间、阻滞完善时间和阻滞维持时间。记录治疗后24 h内不良反应发生情况。结果:3组间T_(1-3)和T_(5-6)时VAS评分和PSQI评分比较差异无统计学意义(P>0.05),Sm组T 4时VAS评分和PSQI评分高于OC组和GT组(P<0.05)。与GT组比较,Sm组阻滞操作时间缩短,阻滞起效时间及完善时间延长,阻滞维持时间缩短,OC组阻滞操作时间缩短,阻滞起效时间及阻滞完善时间缩短(P<0.05),阻滞维持时间差异无统计学意义(P>0.05)。3组均未见严重不良反应的发生。结论:相对于GON阻滞联合TON阻滞而言,超声引导下SCP阻滞治疗ON操作简捷,安全性高,其中OCI-C_(2,3)间隙SCP阻滞起效快,维持时间久,疼痛和睡眠质量改善理想,可作为ON治疗的首选阻滞方式。
ObjectiveTo evaluate the efficacy of ultrasound-guided semispinalis capitis plane(SCP)block for treatment of occipital neuralgia(ON).MethodsThis was a prospective study.Ninety patients of both sexes,aged 29-66 yr,suffering ON for 3 months-6 yr in Zibo Municipal Hospital from January 2022 to December 2023,were divided into 3 groups(n=30 each)using a random number table method:combination of greater occipital nerve(GON)block and the third occipital nerve(TON)block group(group GT),SCP block via the medial head of semispinalis capitis muscle(SCM)group(group Sm),and SCP block via the space between obliquus capitis inferior and C_(2,3) facet joint(OCI-C_(2,3))group(group OC).In GT group,the analgesic and anti-inflammatory compound solution 2.5 ml was injected around GON in the SCM-OCI space at the C_(2) level of the cervical vertebra and at the lateral surface of CO_(2,3) facet joint.In Sm group,the analgesic and anti-inflammatory compound solution 5 ml was injected into the medial head of SCM at the level of C 1.In OC group,the analgesic and anti-inflammatory compound solution 5 ml was injected into the OCI-C_(2,3) space in the deep part of SCM.The Visual Analogue Scale(VAS)score and Pittsburgh Sleep Quality Index(PSQI)score were recorded before treatment(T_(1))and at 1,3,7,10 and 14 days after treatment(T_(2-6)),and then the rates of pain relief and improvement in sleep quality were calculated.The time spent in blocking,onset time of blocking,completion time of blocking,duration of block,and occurrence of adverse reactions within 24 h after block were recorded.ResultsThere were no significant differences in VAS scores and PSQI scores at T_(1-3) and T_(5-6) among the three groups(P>0.05),and VAS and PSQI scores were significantly higher at T 4 in Sm group than in OC and GT groups(P<0.05).Compared with GT group,the time spent in blocking was significantly shortened,the onset time and completion time of block was prolonged,and the duration of block was shortened in Sm group,and the time spent in blocking was significant
作者
王晓刚
孙庆海
孟德福
崔燕红
郑力鹏
常洪波
刘颖
鄂占森
Wang Xiaogang;Sun Qinghai;Meng Defu;Cui Yanhong;Zheng Lipeng;Chang Hongbo;Liu Ying;E Zhansen(Department of Ultrasonography,Zibo Municipal Hospital,Zibo 255400,China;Department of Spine Surgery,Zibo Municipal Hospital,Zibo 255400,China;Department of Pain,Zibo Municipal Hospital,Zibo 255400,China;Department of Ultrasonography,Shenzhen Longgang Central Hospital,Shenzhen 518116,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2024年第9期1117-1121,共5页
Chinese Journal of Anesthesiology
基金
山东省医药卫生科技发展计划项目(202109020358)。
关键词
神经传导阻滞
头半棘肌
超声检查
枕神经痛
Nerve block
Semispinalis capitis
Ultrasonography
Occipital neuralgia
