Green C R, de Rosayro A M
Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor 48109, USA.
Reg Anesth. 1997 Mar-Apr;22(2):188-91. doi: 10.1016/s1098-7339(06)80040-4.
Cutaneous vasculitis is a devastating extra-articular manifestation of rheumatoid arthritis. The potential consequences of digital vasculitis are necrosis, ischemia, infarction, and eventually gangrene.
A 54-year-old woman with a long history of rheumatoid arthritis developed an acute onset of severe diffuse occlusive cutaneous vasculitis beyond the head of the metacarpals (documented by angiogram). Despite treatment with high-dose prednisone and Cytoxan, her symptoms were poorly controlled. Cervical sympatholysis via continuous epidural infusion of bupivacaine was then initiated to manage her pain as well as to treat the vasoconstrictive sequelae of the cutaneous vasculitis.
The cervical epidural infusion relieved the pain and produced significant resolution of the symptoms.
This case highlights the rational use of continuous cervical epidural block for the management of pain and improvement in blood flow to vasoconstricted upper extremities and digits resulting from vasculitis due to rheumatoid vasculitis.
皮肤血管炎是类风湿关节炎一种严重的关节外表现。指端血管炎的潜在后果包括坏死、缺血、梗死，最终导致坏疽。
一名有长期类风湿关节炎病史的54岁女性，在手的掌指关节以上急性发作严重弥漫性闭塞性皮肤血管炎（血管造影证实）。尽管使用大剂量泼尼松和环磷酰胺治疗，其症状仍控制不佳。随后通过持续硬膜外输注布比卡因进行颈交感神经松解术，以控制疼痛，并治疗皮肤血管炎的血管收缩后遗症。
颈段硬膜外输注缓解了疼痛，并使症状得到显著改善。
本病例突出了持续颈段硬膜外阻滞在治疗类风湿性血管炎所致血管炎引起的疼痛以及改善血管收缩的上肢和指端血流方面的合理应用。
