夏克江 吴小琴 杨崇林

[摘要] 目的 探討星状神经节阻滞术（SGB）在颅脑损伤昏迷患者早期促醒中的临床应用。 方法 选取我院2016年10月～2019年10月收治的颅脑损伤昏迷患者150例，根据治疗方法不同分为观察组与对照组各75例，观察组予星状神经节阻滞术治疗，对照组予神经节苷脂钠联合高压氧治疗，评价两组患者的疗效、格拉斯哥昏迷量表（GCS）评分、脑脊液去甲肾上腺素（NE）水平。 结果 观察组患者治疗总有效率92.00%，高于对照组80.00%（P<0.05）。干预前两组GCS评分结果比较，差异无统计学意义（P>0.05）;两组干预后GCS评分均高于干预前（P<0.05）;干预后观察组患者GCS评分高于对照组（P<0.05）。干预前两组脑脊液NE水平比较，差异无统计学意义（P>0.05）;两组干预后脑脊液NE水平均低于干预前（P<0.05）;干预后观察组患者脑脊液NE水平低于对照组（P<0.05）。 结论 星状神经节阻滞术（SGB）治疗可有效促进颅脑损伤昏迷患者早期苏醒，帮助脑中枢神经损伤的患者早期恢复意识，促进脑功能恢复、改善脑循环、恢复脑功能，降低致残率，减轻患者及家属的痛苦，具有较好的社会效益。

[关键词] 星状神经节阻滞术;颅脑损伤;昏迷;促醒

[中图分类号] R651.1          [文献标识码] B          [文章编号] 1673-9701（2020）17-0108-04

Clinical application of stellate ganglion block in early awakening of coma patients with craniocerebral injury

XIA Kejiang1   WU Xiaoqin2   YANG Chonglin1

1.Department of Neurosurgery， Yingtan People's Hospital in Jiangxi Province， Yingtan   335000， China; 2.Department of Neurosurgery， Yingtan Peoples Hospital in Jiangxi Province， Yingtan   335000， China

[Abstract] Objective To explore the clinical application of stellate ganglion block（SGB） in early awakening of coma patients with craniocerebral injury. Methods 150 coma patients with craniocerebral injury admitted to our hospital from October 2016 to October 2019 were selected as the subjects of research and divided into the observation group and the control group with 75 patients in each group according to different treatments. The observation group was treated with SGB， while the control group was treated with ganglioside sodium combined with hyperbaric oxygen. The curative effect， Glasgow Coma Scale（GCS） scores and the norepinephrine （NE） level in cerebrospinal fluid（CSF） of the two groups were evaluated. Results The total effective rate of the observation group was 92.00%， which was higher than the 80.00% of the control group（P<0.05）. Before intervention， there was no statistically significant difference in GCS scores between the two groups（P>0.05）; the GCS scores after intervention were higher than those before intervention in both groups（P<0.05）; after intervention， the GCS scores of the patients in the observation group were higher than those in the control group （P<0.05）. Before intervention， there was no statistically significant difference in the NE level in CSF between the two groups（P>0.05）; after the intervention， the NE level in CSF in both groups was lower than that before the intervention（P<0.05）; after intervention， the NE level in CSF in the observation group was lower than that in the control group（P<0.05）. Conclusion Stellate ganglion block（SGB） can effectively promote the early awakening of coma patients with craniocerebral injury， help the patients with the injury of central nervous system restore consciousness at an early stage， accelerate the recovery of brain functions， improve cerebral circulation， and reduce disability rate. It has soothed the pains of both the patients and their families and received better social benefits.

[Key words] Stellate ganglion block （SGB）;Craniocerebral injury;Coma;Awakening

随着现代城镇居民生活水平不断提高、我国社会人口数量不断增长以及交通工具多样化，我国交通与工伤事故发生率逐年增加，颅脑损伤导致昏迷的发生情况也存在上升趋势[1]。颅脑损伤是常见的外伤类型，可同时复合其他损伤，根据颅脑解剖部位划分为头皮、颅骨、脑损伤，三者也可同时存在。根据病情严重程度将其划分为轻度、中度、重度、特重度。导致颅脑损伤的原因较多，如交通事故、高空坠落、跌倒等[2]，部分重型颅脑损伤患者的致残率与致死率较高。颅脑损伤导致大脑半球产生广泛性损伤，致使大脑皮层功能丧失，患者会随之出现昏迷与无意识状态，长期治疗会增加患者家庭经济压力。为改善疾病预后效果，临床需采取积极手段促使患者早期苏醒[3]。机体出现昏迷的病因较多，如颅脑损伤、中毒、感染等原因，早期促醒是临床治疗昏迷患者的重要环节，也是临床研究的热门方向。……