星状神经节阻滞

一、适应证
1、偏头痛、丛集性头痛
2、头面、胸背及上肢带状疱疹和疱疹后遗神经痛
3、复杂性局部痛综合征
4、幻肢痛
5、急性血管栓塞、雷诺氏病、硬皮病。
6、急性或慢性心绞痛
7、脑血管痉挛等心血管疾病
8、更年期妇女不定陈述综合症
9、过敏性鼻炎、突发性耳聋等
二、解剖

颈部交感神经节位于颈血管鞘的后方,颈椎横突的前方。每侧有三个: 颈上神经节、颈中神经节、颈下神经节。颈下交感神经节也称星状神经节或颈胸交感神经节;其形状不规则,呈卵圆形,放射状,长约2cm,宽约lcm;大于颈中神经节;位于第7颈椎横突基部和第1肋骨颈之间的前方,椎动脉的后方,斜角肌群的内侧;肺尖在其下方;下界位于胸膜后方,被疏松的蜂窝组织及脂肪组织所包裹。发出的灰交通支连接第7、第8颈神经和第1胸神经,还发出分支围绕锁骨下动脉及其分支组成丛,随该动脉到达腋动脉第1段。 一些分支分别围绕椎动脉组成椎动脉丛,进入颅腔,围绕椎动脉及基底动脉,直到大脑后动脉,和起自颈内动脉的神经丛会合。发出的心下神经沿锁骨下动脉后方,气管的前方下降,加入心丛而参与支配心脏的活动。
三、生理功能
主要表现为交感肾上腺系统的兴奋而产生的交感神经系统反应,如心肌收缩力增加、传导功能加速、心率加快。扩张支气管。扩瞳、松弛睫状肌。促进肝糖原分解、升高血糖、肾上腺髓质激素分泌增加等。
四、操作方法

仰卧,肩下垫枕,口微张开,放松颈前肌肉。
用左手食指和中指将胸锁乳突肌和颈总动脉推向外侧。
在食管旁和胸锁乳突肌前缘胸锁关节上方约两横指(环状软骨平面相当于第6颈椎横突)处与皮肤垂直进针。触到骨质,退针少许,回吸无血即可注入局麻药液3-5ml.阻滞成功的标志为注药侧出现霍纳氏综合征。穿刺针触及交感神经节时并无异感。
1、注射期间令患者睁眼,观察注射反应,注射后令患者坐位,2~3min后患者出现同侧霍纳(Horner’s)氏征,则表明阻滞成功。
2、普通患者针进入约2cm左右,针尖触及到横突时患者不出现异感。
3、对肥胖和颈短粗患者,可能深到2.5~3cm左右。如果发现进针比这更深,则有可能针尖刺进两个横突之间。应立即将针退出,再调整针尖向头侧或尾侧方向穿刺,直至针尖触及到横突骨性感觉。
五、并发症
1、喉返神经阻滞。
2、膈神经和臂丛神经阻滞。
3、气胸。
4、硬膜外或蛛网膜下腔阻滞。
5、误注入椎动脉或颈动脉。
6、误注入食管和气管壁或腔内。
六、注意事项:
1、穿刺过深误将局麻药误注入椎动脉内,而引起患者中枢神经性抽搐和呼吸心跳停止。
2、误注入蛛网膜下腔,产生全脊麻导致呼吸抑制、心跳停止。
3、注射药物过浅或接近气管-食管沟,阻滞喉返神经,可导致声音嘶哑。
4、穿刺部位过高或局麻药量过大,可以阻滞膈神经,出现腹式呼吸减弱或因膈神经受刺激而出现呃逆。
应特别提醒术者,在进行本操作过程中,必须边回吸,边进针。甚至一滴或二滴局麻药误入到椎动脉,即可以引起患者抽搐。
穿刺针过于朝向尾侧,容易刺伤胸膜顶或肺尖引发气胸。反复穿刺损伤血管引起出血、血肿和感染。近年有人提出,在颈6和颈7部位穿刺对星状神经节的阻滞效果相似,而前者发生并发症明显少于后者。因此坚持穿刺针尖深度不触及横突根部骨性感不能注药的原则以策安全。
七、霍纳(Horner’s)氏征:、
1.瞳孔缩小。
2.眼睑下垂及眼裂狭小。
3.眼球内陷。
4.患侧额部无汗。

文章来源于网络

星状神经节阻滞》上有64条评论

  1. you can look here

    I just want to tell you that I’m all new to blogs and honestly enjoyed your web blog. More than likely I’m want to bookmark your blog . You amazingly come with outstanding posts. Thanks a bunch for sharing with us your web page.

    回复
  2. Coletta Krupansky

    If you’re nevertheless on the fence: grab your favored earphones, head down in the direction of a Perfect Invest in and request toward plug them into a Zune then an iPod and perspective which just one seems improved towards oneself, and which interface helps make on your own smile added. Then you may realize which is instantly for yourself.

    回复
  3. find more information

    Mosting likely to include my outdated memory froth mattress topper tonight to view if that aids with the additional stiffness. Possibly I just invested very a lot opportunity on the outdated failed up mattress that I changed along with this one.

    回复
  4. Austin Cashett

    It’s reallyactually a nicecoolgreat and helpfuluseful piece of informationinfo. I’mI am satisfiedgladhappy that youthat you simplythat you just shared this helpfuluseful infoinformation with us. Please staykeep us informedup to date like this. Thank youThanks for sharing.

    回复
  5. Health and Fitness

    Thank you for helping out, good information. “The health of nations is more important than the wealth of nations.” by Will Durant.

    回复
  6. Keith Lehtinen

    Good ¡V I should certainly pronounce, impressed with your web site. I had no trouble navigating through all the tabs as well as related info ended up being truly easy to do to access. I recently found what I hoped for before you know it at all. Reasonably unusual. Is likely to appreciate it for those who add forums or anything, web site theme . a tones way for your customer to communicate. Excellent task..

    回复
  7. Health and Fitness

    Thank you a lot for providing individuals with remarkably wonderful chance to check tips from this blog. It can be so fantastic and also jam-packed with a good time for me personally and my office mates to search your web site at the very least 3 times every week to learn the new secrets you will have. And lastly, we’re always astounded with the magnificent solutions you give. Certain 1 facts in this posting are truly the very best I’ve had.

    回复
  8. Health and Fitness

    We are a group of volunteers and starting a new scheme in our community. Your site provided us with valuable information to work on. You have done an impressive job and our entire community will be thankful to you.

    回复
  9. Health and Fitness

    Hiya, I am really glad I have found this information. Nowadays bloggers publish just about gossips and web and this is really frustrating. A good web site with exciting content, this is what I need. Thanks for keeping this web-site, I will be visiting it. Do you do newsletters? Can not find it.

    回复
  10. Health and Fitness

    I was just seeking this info for a while. After 6 hours of continuous Googleing, at last I got it in your website. I wonder what is the lack of Google strategy that don’t rank this kind of informative web sites in top of the list. Normally the top sites are full of garbage.

    回复
  11. Health and Fitness

    hello!,I like your writing so so much! proportion we be in contact more about your post on AOL? I need a specialist on this space to unravel my problem. May be that’s you! Looking forward to peer you.

    回复
  12. Learn how to become a millionaire

    Just imagine for a second if you could get into the mind of a millionaire. Think of all the things that you could learn. Well, you actually can do just that. A millionaire is giving away all of his secret right on the internet. You don’t even need to leave the house to learn what made him rich. All it takes is visiting http://e31a67zd-ccr7u13el2cflqp0d.hop.clickbank.net He will literally teach you all of the secrets to making money. Don’t you think it’s time that you earned the living that you deserve? Change your life today by simply following the link above. Do it for yourself and everyone that you care about.

    回复
  13. Make Money Promoting ClickBank

    Did you know that people make their entire income promoting ClickBank? You too could be one of the many who have quit their job. Affiliate marketing is as old as the internet. It’s not going to go away any time soon. You too can get your piece of the pie. Why shouldn’t you? Do you really like working the job you have? Are you going to be able to do it until you retire? If you’re job requires physical labor, then you know the answer to that question. There’s no way you’re going to be able to do that when you get older. That’s just the truth and no one needs to tell it to you. Right now you could be making money online. Does it require work? You better believe it does. No honest person is ever going to tell you that it’s possible to become a millionaire online without doing any work whatsoever. It’s not possible. That doesn’t mean there isn’t money to be made. There’s plenty of money out there to be made by people just like yourself. Now you know there’s going to be a pitch for a product. You’re right about that. Click on the link http://64efd6-lz41s3rcelbr7s2xl7x.hop.clickbank.net/ and check it out. There’s a video you can watch that will explain everything. It will tell you how to make money using ClickBank. Watch the video and see what you think. You too can be one of the many who earn a living promoting ClickBank. Some people earn a good living and there’s no reason why you can’t.

    回复
  14. kumpulan youtube terbaik

    I think this really is essentially the most vital info to me. Using this program . content studying your own write-up kumpulan youtube terbaik. Nonetheless wish to thoughts for number of frequent challenges, The site design and style is best, a articles is reality great : Deb. Excellent exercise, regards

    回复
  15. Marcus Gyles

    Asking questions are reallyactuallyin facttrulygenuinely nicepleasantgoodfastidious thing if you are not understanding anythingsomething fullycompletelyentirelytotally, butexcepthowever this articlepostpiece of writingparagraph providesoffersgivespresents nicepleasantgoodfastidious understanding evenyet.

    回复
  16. Jenni Marotto

    IMy partner and IMy spouse and IWe absolutely love your blog and find nearly all ofmany ofa lot ofmost ofthe majority ofalmost all of your post’s to be just whatexactlyprecisely whatwhat preciselyexactly whatjust what I’m looking for. Does oneDo youWould youcan you offer guest writers to write content for youavailable for youfor you personallyfor yourselfto suit your needsin your case? I wouldn’t mind composingcreatingproducingpublishingwriting a post or elaborating on a lot of themany of themost of thesome of thea few of thea number of the subjects you write in relation toconcerningaboutregardingrelated towith regards to here. Again, awesome web sitesiteweblogweb logblogwebsite!

    回复
  17. Timothy Subera

    If you wantdesirewish forwould like to takegetobtain mucha great deala good deal from this articlepostpiece of writingparagraph then you have to apply suchthese strategiestechniquesmethods to your won blogweblogwebpagewebsiteweb site.

    回复
  18. Herbert Sablock

    Hi, I do believeI do think this is an excellentthis is a great blogwebsiteweb sitesite. I stumbledupon it 😉 I willI am going toI’m going toI may come backreturnrevisit once againyet again since Isince i have bookmarkedbook markedbook-markedsaved as a favorite it. Money and freedom is the bestis the greatest way to change, may you be rich and continue to helpguide other peopleothers.

    回复
  19. sale car

    Wow! This can be one particular of the most beneficial blogs We have ever arrive across on this subject. Actually Excellent. I am also a specialist in this topic therefore I can understand your effort.

    回复
  20. Deirdre Lilleberg

    My spouse and I stumbled over here different website and thought I might as well check out things. I enjoy what I see so today I am following you. Look forward to checking out your web page repeatedly.

    回复
  21. Make money with social media

    Are you the type who likes to hangout on social media? Have you ever thought about making it a career? You can help promote their business using social media. This means you can do what you already love doing and make money at it. Does this sound like something you’d like to do? If so, then check out http://d526fc0l5b3nfyfg3bx3sfpbkq.hop.clickbank.net/ You can help people and make some money in the process. You already hang out at social media sites. Why not make a few bucks doing it?

    回复
  22. Jaimee Nicklos

    Woah! I’m enjoying the template/theme of this website. It is easy, yet powerful. A lot of times it’s very hard to get that “perfect balance” between superb usability and visual appeal. I have to say you have done an excellent job with this. {

    回复
  23. best brand false eyelashes

    Hi! I know this is kinda off topic but I was wondering which blog
    platform are you using for this site? I’m getting tired of WordPress because I’ve had issues with hackers and I’m looking at options
    for another platform. I would be great if you could point me in the direction of a good platform.

    回复

发表评论

电子邮件地址不会被公开。