Fei Y, Xu M M, Huang B, Xie K Y, Ni H D, Zhang L, Zhang H P, Yao M
Department of Anesthesiology and Pain Medicine, the First Hospital of Jiaxing City, Zhejiang Province, Jiaxing 314001, China.
Zhonghua Yi Xue Za Zhi. 2017 Jun 13;97(22):1729-1733. doi: 10.3760/cma.j.issn.0376-2491.2017.22.011.
To evaluate the value of radial and ulnar arteries hemodynamic changes by ultrasound in patients with primary palmar hyperhidrosis after thoracic sympathetic block. This was a prospective study, from January 2016 to September 2016, 23 patients with primary palmar hyperhidrosis were admitted to the First Hospital of Jiaxing City, Zhejiang Province, 92 arteries of these patients who underwent thoracic sympathetic block were enrolled into this study. Diameters, peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) of the radial and ulnar arteries were examined one day before and after the operation by color Doppler ultrasound. Spectral waveforms of these arteries were observed, and palms temperature (T), oxygen saturation (SpO(2)), perfusion index (PI) were also measured. Diameters, PSV, EDV, RI, T, SpO(2) and PI of the patients with PH were compared before and after the surgery. The effect of operation was also evaluated. Before surgery, diameters and EDV of the radial and ulnar arteries of the patients with PH were(2.12±0.36) mm, (1.50±0.32) mm, (4.90±1.84) cm/s, (4.71±1.65) cm/s, respectively, after surgery, the diameter of the RA, UA and EDV were (2.45±0.54) mm, (1.87±0.44) mm, (9.37±1.69) cm/s and (9.12±1.54) cm/s, which were significantly increased.Before surgery, RI of the RA and UA of the patients were (0.85±0.05), (0.97±0.07) , respectively, after surgery, RI of the RA and UA were (0.57±0.04), (0.64±0.09), respectively, which were significantly decreased after surgery. The difference was statistically significant (=-5.23, -2.33, -19.80, -14.68, 3.31, 3.48, all <0.01). Before surgery, PSV of the RA and UA of the patients were (46.38±15.12) cm/s, (45.60±14.88) cm/s , respectively, after surgery, PSV of the RA and UA were (46.93±16.02) cm/s, (46.19±15.30) cm/s , respectively. The difference was not statistically significant (=-0.23, -1.39, all >0.05). Before surgery, T, SpO(2) and PI of the patients were(29.7±1.04) ℃, (93.24±2.23) %, (1.11±0.13) % , respectively, after surgery, T, SpO(2) and PI of the patients were (35.09±1.21) ℃, (98.10±1.34) %, (4.77±1.22)% , respectively. The difference was statistically significant (=-20.174, -1.140, -23.601, all <0.05). The symptoms of hyperhidrosis of the patients were disappeared immediately after the surgery in both hands. All of the patients were cured within 3 months and there was no severe complications. Thoracic sympathetic block increase Diameters and EDV but decrease RI of the radial and ulnar arteries of the patients with PH and increase the palms temperature. Artery diameters, EDV, and RI measured by ultrasound can be used as parameters to evaluate the effect of thoracic sympathetic block in patients with PH. It's objective, non-invasive and convenient.
通过超声评估原发性手掌多汗症患者胸交感神经阻滞后桡动脉和尺动脉的血流动力学变化价值。这是一项前瞻性研究，2016年1月至2016年9月，浙江省嘉兴市第一医院收治23例原发性手掌多汗症患者，对这些接受胸交感神经阻滞的患者的92条动脉进行研究。采用彩色多普勒超声在手术前后一天检测桡动脉和尺动脉的直径、收缩期峰值流速（PSV）、舒张末期流速（EDV）和阻力指数（RI）。观察这些动脉的频谱波形，并测量手掌温度（T）、血氧饱和度（SpO₂）、灌注指数（PI）。比较PH患者手术前后的直径、PSV、EDV、RI、T、SpO₂和PI。同时评估手术效果。手术前，PH患者桡动脉和尺动脉的直径及EDV分别为（2.12±0.36）mm、（1.50±0.32）mm、（4.90±1.84）cm/s、（4.71±1.65）cm/s，手术后，桡动脉、尺动脉直径及EDV分别为（2.45±0.54）mm、（1.87±0.44）mm、（9.37±1.69）cm/s和（9.12±1.54）cm/s，均显著增加。手术前，患者桡动脉和尺动脉的RI分别为（0.85±0.05）、（0.97±0.07），手术后，桡动脉和尺动脉的RI分别为（0.57±0.04）、（0.64±0.09），手术后显著降低。差异有统计学意义（=-5.23，-2.33，-19.80，-14.68，3.31，3.48，均<0.01）。手术前，患者桡动脉和尺动脉的PSV分别为（46.38±15.12）cm/s、（45.60±14.88）cm/s，手术后，桡动脉和尺动脉的PSV分别为（46.93±16.02）cm/s、（46.19±15.30）cm/s。差异无统计学意义（=-0.23，-1.39，均>0.05）。手术前，患者的T、SpO₂和PI分别为（29.7±1.04）℃、（93.24±2.23）%、（1.11±0.13）%，手术后，患者的T、SpO₂和PI分别为（35.09±1.21）℃、（98.10±1.34）%、（4.77±1.22）%。差异有统计学意义（=-20.174，-1.140，-23.601，均<0.05）。患者双手手术后多汗症状立即消失。所有患者在3个月内治愈，无严重并发症。胸交感神经阻滞可增加PH患者桡动脉和尺动脉的直径及EDV，但降低RI，并提高手掌温度。超声测量的动脉直径、EDV和RI可作为评估PH患者胸交感神经阻滞效果的参数。其具有客观性、无创性且方便。
