星狀神經節阻滯技術進展_West China Medical Journal

Authors：

 周莉 , 吳超然 , 銀燕 ,  楊邦祥

四川大學華西醫院麻醉科（成都 610041）;

Corresponding?author：

楊邦祥, Email: 115826698@qq.com

Keywords：

星狀神經節阻滯; 盲探; 影像學輔助; 超聲

DOI：

10.7507/1002-0179.20150397

Video：

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星狀神經節阻滯是疼痛科臨床工作中重要的診斷和治療方法之一，可以用于100 多種疾病的診治。其原理為將局部麻醉藥物注入星狀神經節周圍的疏松結締組織達到阻滯其相應支配區域的交感神經，進而達到診治的目的。由于星狀神經節解剖位置的特殊性，如何精確地將藥物注射到相應部位提高阻滯的成功率且減少并發癥的發生率一直是學者們研究的熱點。目前關于星狀神經節阻滯技術從盲探技術到醫學影像學設備輔助下（X 線、CT 和MRI）星狀神經節阻滯技術以及超聲引導下星狀神經節阻滯技術都有報道。在參考國內外最新研究的基礎上，對目前臨床上采用的星狀神經節阻滯技術作一綜述，詳細介紹以上阻滯技術的操作要點和優缺點，以期大家在臨床中能夠結合自身的特點選擇最優的阻滯方法，提高該技術的成功率。

Citation： 周莉, 吳超然, 銀燕, 楊邦祥. 星狀神經節阻滯技術進展. West China Medical Journal, 2015, 30(7): 1378-1382. doi: 10.7507/1002-0179.20150397 Copy

1.	Park CG, Kim JS, Lee WH. The effect of stellate ganglion block for controlling postoperative pain after the shoulder joint surgery[J]. Korean J Pain, 2006, 19(2):197-201.
2.	Richard LR. Stellate ganglion block[J]. Tech Reg Anesth Pain Manage, 2001, 5(3):88-93.
3.	Abdi S, Zhou YL, Doshi R, et al. Stellate ganglion block:emphasis on the new oblique fluoroscopic approach[J]. Tech Reg Anesth Pain Manage, 2005, 9(2):73-80.
4.	Matsumoto S. Thermographic assessments of the sympathetic blockade by stellate ganglion block (1) comparison between C7-SGB and C6-SGB in 40 patients[J]. Masui, 1991, 40(4):562-569.
5.	Rauck R. Sympathetic nerve blocks:head, neck and trunk[M]//Raj PP. Practical management of pain[M]. 3rd ed. Philadelphia, PA, Mosby, 2000:651-682.
6.	Wiener L, Cox JW. Influence of stellate ganglion block on angina pectoris and the post-exercise electrocardiogram[J]. Am J Med Sci, 1966, 252(3):289-295.
7.	Moore R, Groves D, Hammond C, et al. Temporary sympathectomy in the treatment of chronic refractory angina[J]. J Pain Symptom Manage, 2005, 30(2):183-191.
8.	Brascher AK, Blunk JA, Bauer K, et al. Comprehensive curriculum for phantom-based training of ultrasound-guided intercostal nerve and stellate ganglion blocks[J]. Pain Med, 2014, 15(10):1647-1656.
9.	Shin HY, Kim DS, Kim SS. Superficial cervical plexus block for management of herpes zoster neuralgia in the C₃ dermatome:a case report[J]. J Med Case Rep, 2014, 8(8):59.
10.	Loyalka P, Hariharan R, Gholkar G, et al. Left stellate ganglion block for continuous ventricular arrhythmias during percutaneous left ventricular assist device support[J]. Tex Heart Inst J, 2011, 38(4):409-411.
11.	Schürmann M, Gradl G, Wizgal I, et al. Clinical and physiologic evaluation of stellate ganglion blockade for complex regional pain syndrome type Ⅰ[J]. Clin J Pain, 2001, 17(1):94-100.
12.	Erickson SJ, Hogan QH. CT-guided injection of the stellate ganglion:description of technique and efficacy of sympathetic blockade[J]. Radiology, 1993, 188(3):707-709.
13.	Forouzanfar T, Van Kleef M, Weber WE. Radiofrequency lesions of the stellate ganglion in chronic pain syndromes:retrospective analysis of clinical efficacy in 86 patients[J]. Clin J Pain, 2000, 16(2):164-168.
14.	Katritsis ED, Lykaki-Anastopoulou G, Papadopoulos NJ. The relations of the superior pole of the stellate ganglion to the vertebral artery[J]. Anat Anz, 1981, 150(3):259-263.
15.	Cha YD, Lee SK, Kim TJ, et al. The neck crease as a landmark of Chassaignac's tubercle in stellate ganglion block:anatomical and radiological evaluation[J]. Acta Anaesthesiol Scand, 2002, 46(1):100-102.
16.	Ate? Y, Asik I, Ozgencil E, et al. Evaluation of the longus colli muscle in relation to stellate ganglion block[J]. Reg Anesth Pain Med, 2009, 34(3):219-223.
17.	Aeschbach A, Mekhail NA. Common nerve blocks in chronic pain management[J]. Anesthesiol Clin North America, 2000, 18(2):429-459, viii.
18.	邱衛紅, 黃新軍. 氣管旁入法與高位側入法行星狀神經節阻滯的解剖學比較[J]. 解剖學研究, 2009, 31(4):274-276.
19.	Nabil Abbas D, Abd El Ghafar EM, Ibrahim WA, et al. Fluoroscopic stellate ganglion block for postmastectomy pain:a comparison of the classic anterior approach and the oblique approach[J]. Clin J Pain, 2011, 27(3):207-213.
20.	趙鵬. 淺談星狀神經節阻滯技術的進展[J]. 重慶醫學, 2010, 39(16):2217-2219.
21.	鄧兆宏, 孫萬群. 星狀神經節阻滯入路的應用解剖[J]. 鄖陽醫學院學報, 2007, 26(1):44-45.
22.	Kiray A, Arman C, Naderi S, et al. Surgical anatomy of the cervical sympathetic trunk[J]. Clinical Anatomy, 2005, 18(3):179-185.
23.	Christie JM, Martinez CR. Computerized axial tomography to define the distribution of solution after stellate ganglion nerve block[J]. J Clin Anesth, 1995, 7(4):306-311.
24.	Shibata Y, Fujiwara Y, Komatsu T. A new approach of ultrasoundguided stellate ganglion block[J]. Anesth Analg, 2007, 105(2):550-551.
25.	Moore K, Dalley A. Clincally oriented anatomy[M]. 5th ed. Philadelphia:Lippincott Williams & Wilkins, 2006:1051-1082.
26.	Ellis H, Feldman S. Anatomy for anesthetists[M]. 3rd ed. Oxford, UK:Blackwell Scientific Publications, 1979:256-262.
27.	史珞, 胡文晟, 湯淑芬, 等. 星狀神經節阻滯改良前入路法[J]. 疼痛學雜志, 1997, 5(1):13-15.
28.	Amhaz HH, Manders L, Chidiac EJ, et al. Unusual case of contralateral Horner's syndrome following stellate-ganglion block:a case report and review of the literature[J]. Local Reg Anesth, 2013, 6:31-33.
29.	陳懷. 肌間溝側入法星狀神經節阻滯[J]. 疼痛學雜志, 1996, 4(1):8-9.
30.	吳春友. 改良側入法星狀神經節阻滯[J]. 疼痛學雜志, 1995, 3(2):57.
31.	Malmqvist EL, Bengtsson M, S?rensen J. Effcacy of stellate ganglion block:a clinical study with bupivacaine[J]. Reg Anesth, 1993, 17(6):340-347.
32.	周志華. 頸_6與頸_7橫突星狀神經節阻滯法的比較[J]. 中國疼痛醫學雜志, 1997, 3(2):112-113.
33.	Janik JE, HoeftMA, Ajar AH, et al. Variable osteology of the sixth cervical vertebra in relation to stellate ganglion block[J]. Reg Anesth Pain Med, 2008, 33(2):102-108.
34.	Hogan QH, Abram SE. Neural blockade for diagnosis and prognosis. A review[J]. Anesthesiology, 1997, 86(1):216-241.
35.	Park JS, Kim KJ, Lee YW, et al. Estimation of stellate ganglion block injection point using the cricoid cartilage as landmark through x-ray review[J]. Korean J Pain, 2011, 24(3):141-145.
36.	Elias M. Cervical sympathetic and stellate ganglion blocks[J]. Pain Physician, 2000, 3(3):294-304.
37.	Abdi S, Zhou Y, Patel N, et al. A new and easy technique to block the stellate ganglion[J]. Pain Physician, 2004, 7(3):327-331.
38.	Hogan QH, Erickson SJ. MR imaging of the stellate ganglion:normal appearance[J]. AJR Am J Roentgenol, 1992, 158(3):655-659.
39.	Hogan QH, Erickson SJ, Abram SE. Computerized tomographyguided stellate ganglion blockade[J]. Anesthesiology, 1992, 77(3):596-599.
40.	Bauman JM, Middaugh RE, Cawthon MA, et al. Radionuclideanesthetic flow study:a new technique for the study of regional anesthesia[J]. J Nucl Med, 1986, 27(9):1487-1489.
41.	Curatolo M, Eichenberger U. Ultrasound-guided blocks for the treatment of chronic pain[J]. Tech Reg Anesth Pain Manage, 2007, 11(2):95-102.
42.	Kapral S, Krafft P, Gosch M, et al. Ultrasound imaging for stellate ganglion block:direct visualization of puncture site and local anesthetic spread. A pilot study[J]. Reg Anesth, 1995, 20(4):323-328.
43.	Narouze S. Ultrasound-guided stellate ganglion block:safety and efficacy[J]. Curr Pain Headache Rep, 2014, 18(6):424.
44.	Gofeld M, Bhatia A, Abbas S, et al. Development and validation of a new technique for ultrasound-guided stellate ganglion block[J]. Reg Anesth Pain Med, 2009, 34(5):475-479.
45.	Bhatia A, Flamer D, Peng PW. Evaluation of sonoanatomy relevant to performing stellate ganglion blocks using anterior and lateral simulated approaches:an observational study[J]. Can J Anaesth, 2012, 59(11):1040-1047.
46.	Nix CM, Harmon DC. Avoiding intravascular injection during ultrasound-guided stellate ganglion block[J]. Anaesthesia, 2011, 66(2):134-135.

1. Park CG, Kim JS, Lee WH. The effect of stellate ganglion block for controlling postoperative pain after the shoulder joint surgery[J]. Korean J Pain, 2006, 19(2):197-201.
2. Richard LR. Stellate ganglion block[J]. Tech Reg Anesth Pain Manage, 2001, 5(3):88-93.
3. Abdi S, Zhou YL, Doshi R, et al. Stellate ganglion block:emphasis on the new oblique fluoroscopic approach[J]. Tech Reg Anesth Pain Manage, 2005, 9(2):73-80.
4. Matsumoto S. Thermographic assessments of the sympathetic blockade by stellate ganglion block (1) comparison between C7-SGB and C6-SGB in 40 patients[J]. Masui, 1991, 40(4):562-569.
5. Rauck R. Sympathetic nerve blocks:head, neck and trunk[M]//Raj PP. Practical management of pain[M]. 3rd ed. Philadelphia, PA, Mosby, 2000:651-682.
6. Wiener L, Cox JW. Influence of stellate ganglion block on angina pectoris and the post-exercise electrocardiogram[J]. Am J Med Sci, 1966, 252(3):289-295.
7. Moore R, Groves D, Hammond C, et al. Temporary sympathectomy in the treatment of chronic refractory angina[J]. J Pain Symptom Manage, 2005, 30(2):183-191.
8. Brascher AK, Blunk JA, Bauer K, et al. Comprehensive curriculum for phantom-based training of ultrasound-guided intercostal nerve and stellate ganglion blocks[J]. Pain Med, 2014, 15(10):1647-1656.
9. Shin HY, Kim DS, Kim SS. Superficial cervical plexus block for management of herpes zoster neuralgia in the C₃ dermatome:a case report[J]. J Med Case Rep, 2014, 8(8):59.
10. Loyalka P, Hariharan R, Gholkar G, et al. Left stellate ganglion block for continuous ventricular arrhythmias during percutaneous left ventricular assist device support[J]. Tex Heart Inst J, 2011, 38(4):409-411.
11. Schürmann M, Gradl G, Wizgal I, et al. Clinical and physiologic evaluation of stellate ganglion blockade for complex regional pain syndrome type Ⅰ[J]. Clin J Pain, 2001, 17(1):94-100.
12. Erickson SJ, Hogan QH. CT-guided injection of the stellate ganglion:description of technique and efficacy of sympathetic blockade[J]. Radiology, 1993, 188(3):707-709.
13. Forouzanfar T, Van Kleef M, Weber WE. Radiofrequency lesions of the stellate ganglion in chronic pain syndromes:retrospective analysis of clinical efficacy in 86 patients[J]. Clin J Pain, 2000, 16(2):164-168.
14. Katritsis ED, Lykaki-Anastopoulou G, Papadopoulos NJ. The relations of the superior pole of the stellate ganglion to the vertebral artery[J]. Anat Anz, 1981, 150(3):259-263.
15. Cha YD, Lee SK, Kim TJ, et al. The neck crease as a landmark of Chassaignac's tubercle in stellate ganglion block:anatomical and radiological evaluation[J]. Acta Anaesthesiol Scand, 2002, 46(1):100-102.
16. Ate? Y, Asik I, Ozgencil E, et al. Evaluation of the longus colli muscle in relation to stellate ganglion block[J]. Reg Anesth Pain Med, 2009, 34(3):219-223.
17. Aeschbach A, Mekhail NA. Common nerve blocks in chronic pain management[J]. Anesthesiol Clin North America, 2000, 18(2):429-459, viii.
18. 邱衛紅, 黃新軍. 氣管旁入法與高位側入法行星狀神經節阻滯的解剖學比較[J]. 解剖學研究, 2009, 31(4):274-276.
19. Nabil Abbas D, Abd El Ghafar EM, Ibrahim WA, et al. Fluoroscopic stellate ganglion block for postmastectomy pain:a comparison of the classic anterior approach and the oblique approach[J]. Clin J Pain, 2011, 27(3):207-213.
20. 趙鵬. 淺談星狀神經節阻滯技術的進展[J]. 重慶醫學, 2010, 39(16):2217-2219.
21. 鄧兆宏, 孫萬群. 星狀神經節阻滯入路的應用解剖[J]. 鄖陽醫學院學報, 2007, 26(1):44-45.
22. Kiray A, Arman C, Naderi S, et al. Surgical anatomy of the cervical sympathetic trunk[J]. Clinical Anatomy, 2005, 18(3):179-185.
23. Christie JM, Martinez CR. Computerized axial tomography to define the distribution of solution after stellate ganglion nerve block[J]. J Clin Anesth, 1995, 7(4):306-311.
24. Shibata Y, Fujiwara Y, Komatsu T. A new approach of ultrasoundguided stellate ganglion block[J]. Anesth Analg, 2007, 105(2):550-551.
25. Moore K, Dalley A. Clincally oriented anatomy[M]. 5th ed. Philadelphia:Lippincott Williams & Wilkins, 2006:1051-1082.
26. Ellis H, Feldman S. Anatomy for anesthetists[M]. 3rd ed. Oxford, UK:Blackwell Scientific Publications, 1979:256-262.
27. 史珞, 胡文晟, 湯淑芬, 等. 星狀神經節阻滯改良前入路法[J]. 疼痛學雜志, 1997, 5(1):13-15.
28. Amhaz HH, Manders L, Chidiac EJ, et al. Unusual case of contralateral Horner's syndrome following stellate-ganglion block:a case report and review of the literature[J]. Local Reg Anesth, 2013, 6:31-33.
29. 陳懷. 肌間溝側入法星狀神經節阻滯[J]. 疼痛學雜志, 1996, 4(1):8-9.
30. 吳春友. 改良側入法星狀神經節阻滯[J]. 疼痛學雜志, 1995, 3(2):57.
31. Malmqvist EL, Bengtsson M, S?rensen J. Effcacy of stellate ganglion block:a clinical study with bupivacaine[J]. Reg Anesth, 1993, 17(6):340-347.
32. 周志華. 頸_6與頸_7橫突星狀神經節阻滯法的比較[J]. 中國疼痛醫學雜志, 1997, 3(2):112-113.
33. Janik JE, HoeftMA, Ajar AH, et al. Variable osteology of the sixth cervical vertebra in relation to stellate ganglion block[J]. Reg Anesth Pain Med, 2008, 33(2):102-108.
34. Hogan QH, Abram SE. Neural blockade for diagnosis and prognosis. A review[J]. Anesthesiology, 1997, 86(1):216-241.
35. Park JS, Kim KJ, Lee YW, et al. Estimation of stellate ganglion block injection point using the cricoid cartilage as landmark through x-ray review[J]. Korean J Pain, 2011, 24(3):141-145.
36. Elias M. Cervical sympathetic and stellate ganglion blocks[J]. Pain Physician, 2000, 3(3):294-304.
37. Abdi S, Zhou Y, Patel N, et al. A new and easy technique to block the stellate ganglion[J]. Pain Physician, 2004, 7(3):327-331.
38. Hogan QH, Erickson SJ. MR imaging of the stellate ganglion:normal appearance[J]. AJR Am J Roentgenol, 1992, 158(3):655-659.
39. Hogan QH, Erickson SJ, Abram SE. Computerized tomographyguided stellate ganglion blockade[J]. Anesthesiology, 1992, 77(3):596-599.
40. Bauman JM, Middaugh RE, Cawthon MA, et al. Radionuclideanesthetic flow study:a new technique for the study of regional anesthesia[J]. J Nucl Med, 1986, 27(9):1487-1489.
41. Curatolo M, Eichenberger U. Ultrasound-guided blocks for the treatment of chronic pain[J]. Tech Reg Anesth Pain Manage, 2007, 11(2):95-102.
42. Kapral S, Krafft P, Gosch M, et al. Ultrasound imaging for stellate ganglion block:direct visualization of puncture site and local anesthetic spread. A pilot study[J]. Reg Anesth, 1995, 20(4):323-328.
43. Narouze S. Ultrasound-guided stellate ganglion block:safety and efficacy[J]. Curr Pain Headache Rep, 2014, 18(6):424.
44. Gofeld M, Bhatia A, Abbas S, et al. Development and validation of a new technique for ultrasound-guided stellate ganglion block[J]. Reg Anesth Pain Med, 2009, 34(5):475-479.
45. Bhatia A, Flamer D, Peng PW. Evaluation of sonoanatomy relevant to performing stellate ganglion blocks using anterior and lateral simulated approaches:an observational study[J]. Can J Anaesth, 2012, 59(11):1040-1047.
46. Nix CM, Harmon DC. Avoiding intravascular injection during ultrasound-guided stellate ganglion block[J]. Anaesthesia, 2011, 66(2):134-135.

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