硬脊膜外腔阻滞治疗血栓闭塞性脉管炎的临床研究

CLINICAL STUDY OF THE THERAPEUTIC EFFECT OF EPIDURAL BLOCK FOR THROMBOANGIITIS OBLITERANCE

摘要:

目的 :应用硬脊膜外腔阻滞方法观察治疗血栓闭塞性脉管炎的疗效。方法 :选择血栓闭塞性脉管炎I、II期的病人 4 7例 ,随机分为三组 :A组 ,硬脊膜外腔阻滞 ;B组 :腰交感神经节阻滞 ;C组 :坐骨神经阻滞。所用药物为利多卡因和康宁克通A混合液。每周治疗一次、三次为一疗程 ,用视觉模拟评分法 (VAS)测痛记分和肢体温度变化为指标 ,观察疗效。每组在治疗前和治疗后 15、30、4 5分钟 ,分别测定各项指标 ,然后进行统计学处理。结果 :A组VAS治疗前 8.2 5± 1.13,治疗后降至 0 .6 3± 1.18。B组 ,由 8.2 7± 1.14降至 1.2 4± 1.0 6。C组由 8.2 3± 1.12降至 1.2 3± 1.0 5。肢体温度 :A组 ,由治疗前 2 5 .7± 1.13℃升至 2 8.4± 1.17℃。B组 ,由 2 5 .3± 1.4 1℃升至 2 7.9± 1.13℃。C组无变化。A、B组和C组比较P <0 .0 1,差异显著。结论 :血栓闭塞性脉管炎在第I、II期 (以肢体血管功能性改变为主 )用硬脊膜外腔阻滞或腰交感神经阻滞的方法 ,可以使血管舒张 ,增加血流 ,又有镇痛作用 ,可以达到治疗的目的 ;而单纯神经阻滞只起到暂时性镇痛作用 ,对疾病本身无效。

Abstract:

Objective: To observe the therapeutic effect of epidural block for thromboangiitis obliterans (Buerger's disease). Method: 47 cases were divided into 3 groups. Group A was treated with epidural block, group B with lumbarsympathetic ganglia block, and group C with sciatic nerve block. The drug injected was a mixture of lidocaine and kenacort A. The injections were given once a week for three weeks. During the study, pain score was determined by visual analogue scale (VAS) and limb temperature was recorded. Result: All groups showed a significant decrease of VAS. However, only group A and B showed significant increase in limb temperature. Conclusion: Epidural block and sympathetic block were effective methods for treating Buerger's disease. Sciatic nerve block was effective for pain relief but not for the treatment of disease.