Bataille Benoît, Nucci Bastian, Mora Michel, Silva Stein, Cocquet Pierre
Service de Réanimation Polyvalente, Centre Hospitalier de Narbonne, Bd Dr Lacroix, 11100, Narbonne, France.
Pôle Anesthésie-Réanimation, Centre Hospitalier Universitaire, CHU Purpan, Toulouse, France.
Can J Anaesth. 2016 Jan;63(1):56-60. doi: 10.1007/s12630-015-0503-z. Epub 2015 Sep 28.
This case report describes the use of ultrasound-guided stellate ganglion blockade to treat sepsis-related digital ischemia in the intensive care unit (ICU).
A 71-yr-old female was admitted to the ICU with septic shock and acute respiratory distress syndrome (ARDS) following an initial right hemicolectomy complicated by an anastomotic leak and peritonitis. The patient's condition was further complicated by an abdominal abscess 22 days later. She had type-2 diabetes mellitus and hypertension but no history of vascular disease. With continuing sepsis from the abscess and requiring mechanical ventilation due to ARDS, she developed upper limb digital ischemia refractory to treatment with a low dose of dobutamine and isosorbide dinitrate. We subsequently performed ultrasound-guided bilateral stellate ganglion blockade with the intent of restoring perfusion to her fingers before digital necrosis developed. One hour after each stellate ganglion block, the symptoms of digital ischemia completely resolved. The benefit persisted for two days, and then a repeat block was performed with similar results.
This case illustrates the potential advantages of ultrasound-guided stellate ganglion blockade for the treatment of sepsis-related digital ischemia refractory to standard therapy.
本病例报告描述了在重症监护病房（ICU）中使用超声引导下星状神经节阻滞治疗脓毒症相关的手指缺血。
一名71岁女性因初次右半结肠切除术后并发吻合口漏和腹膜炎，以感染性休克和急性呼吸窘迫综合征（ARDS）收入ICU。22天后，患者病情因腹部脓肿而进一步复杂化。她患有2型糖尿病和高血压，但无血管疾病史。由于脓肿持续存在脓毒症且因ARDS需要机械通气，她出现了上肢手指缺血，对低剂量多巴酚丁胺和硝酸异山梨酯治疗无效。我们随后进行了超声引导下双侧星状神经节阻滞，目的是在手指坏死发生前恢复其灌注。每次星状神经节阻滞后1小时，手指缺血症状完全缓解。这种益处持续了两天，之后再次进行阻滞，结果相似。
本病例说明了超声引导下星状神经节阻滞在治疗对标准治疗无效的脓毒症相关手指缺血方面的潜在优势。
