Wang Yeming, Yan Guozhong, Xing Zhen, Feng Tengchen, Li Shutie, Zhao Jibo, Teng Jinliang
Department of Anesthesiology, The First Affiliated Hospital of Hebei North University Qiaoxi District, Zhangjiakou 075000, Hebei, China.
Department of Anesthesiology, Kaifeng Central Hospital Longting District, Kaifeng 475000, Henan, China.
Am J Transl Res. 2023 Jun 15;15(6):4129-4137. eCollection 2023.
To analyze the effect and safety of ultrasound-guided continuous stellate ganglion blockade (CSGB) on neurovascular headache.
The clinical data of 137 patients with neurovascular headache treated in the First Affiliated Hospital of Hebei North University from March 2019 to October 2021 were analyzed retrospectively. According to the treatment schemes, the patients were assigned to the control group (69 cases, treated with flunarizine combined with Oryzanol tablets), or the observation group (68 cases, treated with ultrasound-guided CSGB on the basis of the treatment to the control group). The efficacy, headache symptoms, negative emotions, cerebral artery blood flow velocity, vasoactive substance levels and adverse reactions of the two groups were compared. Univariate and logistic multivariate analyses were conducted to explore the risk factors for recurrence of neurovascular headache after treatment.
The observation group showed a notably higher total effective rate than the control group (95.59% 84.06%, <0.05). In contrast to the control group, the observation group had notably lower self-rating depression scale (SDS) and Self-Rating Anxiety Scale (SAS) scores and showed notably lower posterior cerebral artery (PCA), middle cerebral artery (MCA), basilar artery (BA) and anterior cerebral artery (ACA) levels (P<0.05). After the treatment, the observation group showed higher levels of serum 5-hydroxy tryptamine (5-HT) and Beta-Endorphin (β-EP) than the control group, but a lower serum neurotensin (NT) level than the control group. Moreover, the incidence of adverse reactions in the two groups was not greatly different (10.29% 5.80%). The observation group showed a lower recurrence rate within 6 months after treatment than the control group (5.88% 18.84%, P<0.05). Univariate and logistic multivariate analyses showed that occupation (physical labor), smoking history and sleep quality (poor) may be the risk factors for recurrence of neurovascular headache after treatment (>1, <0.05), while CSGB may be the protective factor (OR<1, P<0.05).
Ultrasound-guided CSGB has obvious analgesic effect on patients with neurovascular headache, which can shorten the duration of headache, improve the cerebral artery blood flow velocity, regulate the levels of vasoactive substances, relieve negative emotions, and lower the recurrence rate, with a high safety.
分析超声引导下星状神经节连续阻滞（CSGB）治疗神经血管性头痛的效果及安全性。
回顾性分析河北北方学院附属第一医院2019年3月至2021年10月收治的137例神经血管性头痛患者的临床资料。根据治疗方案，将患者分为对照组（69例，采用氟桂利嗪联合谷维素片治疗）和观察组（68例，在对照组治疗基础上加用超声引导下CSGB）。比较两组的疗效、头痛症状、负性情绪、脑动脉血流速度、血管活性物质水平及不良反应。进行单因素和logistic多因素分析，探讨治疗后神经血管性头痛复发的危险因素。
观察组总有效率显著高于对照组（95.59%对84.06%，P<0.05）。与对照组相比，观察组的自评抑郁量表（SDS）和自评焦虑量表（SAS）评分显著更低，大脑后动脉（PCA）、大脑中动脉（MCA）、基底动脉（BA）和大脑前动脉（ACA）水平显著更低（P<0.05）。治疗后，观察组血清5-羟色胺（5-HT）和β-内啡肽（β-EP）水平高于对照组，但血清神经降压素（NT）水平低于对照组。此外，两组不良反应发生率差异不大（10.29%对5.80%）。观察组治疗后6个月内复发率低于对照组（5.88%对18.84%，P<0.05）。单因素和logistic多因素分析显示，职业（体力劳动）、吸烟史和睡眠质量（差）可能是治疗后神经血管性头痛复发的危险因素（OR>1，P<0.05），而CSGB可能是保护因素（OR<1，P<0.05）。
超声引导下CSGB对神经血管性头痛患者有明显镇痛效果，可缩短头痛持续时间，改善脑动脉血流速度，调节血管活性物质水平，缓解负性情绪，降低复发率，安全性高。
