星狀神經節阻斷對於裴耳氏麻痺患者所產生頭頸部及上肢之生理反應與臨床療效

Effects of Stellate Ganglion Block on Physical Change of Head, Neck and Upper Extremities and effectiveness of treatment in Bell’s Palsy Patients

盧奕丞(I-Chen Lu)

指導教授 ： 湯兆舜

高雄醫學大學/醫學院/醫學研究所/碩士(2005年)

摘要

背景及目的：裴耳氏麻痺(Bell’s palsy )即非特異性周邊顏面神經病變，患者突發造成單側完全性顏面表情肌無功能或功能不全。其致病原因文獻上列有缺血、病毒感染、先天性面神經管狹窄與不明原因。致病原因終究起來與顏面神經鞘上微血管(vasa nervorum)循環障礙有關。針對打破循環障礙之病因，一般認為神經阻斷術是有效的方法之一。2004年Gilden提出裴耳氏麻痺之回顧文獻，但其中治療方式僅探討藥物治療與手術減壓，並無提及星狀神經節阻斷術。而回顧國內文獻，早在1973年曾便提出以星狀神經節阻斷術( stellate ganglion block)作為治療裴耳氏麻痺的有效方式。本研究係以疼痛門診之三十一例裴耳氏麻痺的病患，接受星狀神經節阻斷術作為治療主力並且評估其療效。並以文獻雷射杜卜勒測量儀(Laser doppler flowmetry)之結果為基礎，同時以數位紅外線影像系統探討星狀神經節阻斷術之生理反應，以玆證明星狀神經節阻斷術對於裴耳氏麻痺的療效。
研究設計：從2004年4月至11月間於疼痛門診，收集三十一個裴耳氏麻痺患者(十七位女性,十四位男性,平均年齡36.7歲)，每位患者每週兩次，每次以6 ml 的 1% lidocaine在第六頸椎橫突的底部施行星狀神經節阻斷，施行四週，共八次。施行星狀神經節阻斷術之效果與程度的差異性則以數位紅外線影像系統來分析。在施行星狀神經節阻斷術前與阻斷術後第5,10,15,20,25,30分鐘分別以數位紅外線熱影像分析,並紀錄患側與非患側五個地方的溫度(額部、頰部、唇部、頸部、手掌)。其中三十位病人在被施行星狀神經節阻斷術後呈現明顯霍納氏症候群( Horner’s syndrome)，且納入計算數據，另一位則排除在外；過程中沒有發現任何嚴重副作用。我們使用Paired t-test來檢驗結果。
實驗結果：我們紀錄的五個部位在施行星狀神經節阻斷術後溫度會隨著時間上升,最高溫在10分鐘後出現,平均溫度有統計意義的增加了1.40±0.54℃(p<0.05)。在紀錄的五個部位中,唇部在10分鐘後上升2.50℃為最多。患側的表面溫度比非患側多增加了0.22±0.07℃(p>0.05),但這並沒有統計上的意義。除此之外，數位紅外線影像系統也可以將頭、頸及手臂各部分的體表溫度變化以彩階影像呈現，驗證星狀神經節阻斷術後之生理反應，包括促進頭頸部血流循環，表皮體溫上升，增加熱能分佈。在本研究追蹤治療一個月後，裴耳氏麻痺患者完全治癒率達93.5%。
研究結論：我們的實驗結果證實數位紅外線影像系統則是一個評估星狀神經節阻斷術效果的有效方法；而星狀神經節阻斷術可以增加裴耳氏麻痺患者頭頸部之血液循環,進而達到治療效果。

關鍵字

星狀神經節阻斷術 ； 裴耳氏麻痺 ； 數位紅外線影像系統

並列摘要

Background and aim：Bell’s palsy is defined as peripheral idiopathic facial palsy. Those patients suffered from acute unilateral facial weakness to different extent from mild to severe. The etiology of Bell’s palsy may be due to ischemia, virus infection, congenital infection and unkown. No matter what the cause is, the dysregulation of vasa nervorum microcirculation played a major role in Bell’s palsy. Nerve block was considered as one of an effective method to interrupt dysregulation of circulation. About therapy for Bell’s palsy, merely medical treatment and surgical decompression were discussed in recent review article. However, stellate ganglion block(SGB) has been reported to of excellent efficiency for treatment of Bell’s palsy in our previous study. We evaluated recovery of 31 cases of Bell’s palsy who received SGB as a major part of therapy. Meanwhile, we also investigated in physiological changes after stellate ganglion block by using digital infrared thermography system and reference of laser doppler flowmetry. The goal of this study was to present thermographic assessment of the effectiveness of stellate ganglion block performed for Bell’s palsy patients.
Methods：We collected 31 Bell’s palsy patients (17 females, 14 males ,average age 36.7 years old) in this study from April 2004 to November 2004 in pain clinic. We performed SGB at the base of 6th cervical transverse process with 6 ml of 1% plain lidocaine. Every patients received stellate ganglion block twice a week for one month, total block number of each patient was eight. The extent and degree of sympathetic blockade before and after SGB was evaluated by the digital infrared thermography system. Thermography was performed before and 5,10,15,20,25,30 minutes after SGB respectively. We documented temperature change at 5 areas of both lesion and non-lesion sides: (1)frontal , (2)cheek, (3)labial, (4)neck, (5)palm. We excluded one subject who did not show Horner's syndrome. No severe side effect occurred in each patient. Paired t-test was applied to examined our result.
Results：We noted that after SGB surface temperature of bilateral five detected areas were increasing as time went by. The highest temperature occurred at 10 minute after SGB, and average increase temperature was 1.40±0.54 ℃ which was of statistical significance(P<0.05). Among all 5 areas we investigated, labial region was of highest increased surface temperature at 10 minute post-SGB ; it was 2.50℃ higher than surface temperature pre-SGB. Average increased surface temperature of lesion side was 0.22±0.07℃ higher than non-lesion side, but it was not of statistical significance(p>0.05). Digital infrared thermography system could revealed surface temperature change of head , neck and forearm in color image; furthermore, it also provided evidence of physical change after SGB such as improvement of blood circulation of head and neck, increase in surface temperature and enhancement of heat distribution. In our study the rate of total recovery was 93.5 percent within one month period of treatment and following up.
Conclusion：Thermography is a useful method for the assessment of stellate blockade effectiveness. Our result supported the affirmative value of stellate ganglion block in improving the blood circulation of Bell’s palsy patients.

並列關鍵字

Bell’s palsy ； stellate ganglion block ； infrared thermal image system

參考文獻

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