Bouwman D L, Morrison S, Lucas C E, Ledgerwood A M
J Trauma. 1980 Sep;20(9):744-9.
Sympathectomy has been advocated in the therapy of acute frostbite because ischemia is one determinant of injury severity. Among 66 frostbite victims treated from 1976 through 1978, a group of 15 patients with acute, bilaterally equal injuries judged to be third or fourth degree were treated with immediate intra-arterial reserpine (IAR) in one limb and ipsilateral sympathectomy. Three additional patients who were excellent candidates underwent immediate sympathectomy. The average interval from injury to IAR injection was 3 hours (range 1 to 24 hours). The average interval from injury to sympathectomy was 3 days (range, 12 hours to 10 days). Efficacy of therapy was assessed by comparison of the sympathectomized limb to the contralateral untreated limb. There was no conservation of tissue, resolution of edema, pain reduction, or improved function in sympathectomized limbs compared with those treated with IAR. One patient demarcated more rapidly and one other patient appeared to be protected from recurrent injury. Sympathectomy was not effective therapy for acute frostbite even when achieved early with IAR. Late protection against subsequent cold injury appears to be the only benefit of sympathectomy for frostbite.
由于局部缺血是损伤严重程度的决定因素之一，交感神经切除术一直被提倡用于急性冻伤的治疗。在1976年至1978年治疗的66例冻伤患者中，一组15例双侧损伤程度相同、被判定为三度或四度的急性患者，一侧肢体接受了立即动脉内注射利血平（IAR）治疗，对侧肢体接受了同侧交感神经切除术。另外3例非常适合手术的患者接受了立即交感神经切除术。从受伤到注射IAR的平均间隔时间为3小时（范围1至24小时）。从受伤到交感神经切除术的平均间隔时间为3天（范围12小时至10天）。通过将接受交感神经切除术的肢体与对侧未治疗的肢体进行比较来评估治疗效果。与接受IAR治疗的肢体相比，交感神经切除术后的肢体在组织保留、水肿消退、疼痛减轻或功能改善方面并无差异。1例患者截肢更快，另1例患者似乎免受了反复损伤。即使与IAR联合早期进行，交感神经切除术对急性冻伤也不是有效的治疗方法。交感神经切除术对冻伤的唯一益处似乎是对后续冷损伤的后期保护。
