星状神经节阻滞技术进展_West China Medical Journal

Authors：

 周莉 , 吴超然 , 银燕 ,  杨邦祥

四川大学华西医院麻醉科（成都 610041）;

Corresponding author：

杨邦祥, Email: 115826698@qq.com

Keywords：

星状神经节阻滞; 盲探; 影像学辅助; 超声

DOI：

10.7507/1002-0179.20150397

Video：

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星状神经节阻滞是疼痛科临床工作中重要的诊断和治疗方法之一，可以用于100 多种疾病的诊治。其原理为将局部麻醉药物注入星状神经节周围的疏松结缔组织达到阻滞其相应支配区域的交感神经，进而达到诊治的目的。由于星状神经节解剖位置的特殊性，如何精确地将药物注射到相应部位提高阻滞的成功率且减少并发症的发生率一直是学者们研究的热点。目前关于星状神经节阻滞技术从盲探技术到医学影像学设备辅助下（X 线、CT 和MRI）星状神经节阻滞技术以及超声引导下星状神经节阻滞技术都有报道。在参考国内外最新研究的基础上，对目前临床上采用的星状神经节阻滞技术作一综述，详细介绍以上阻滞技术的操作要点和优缺点，以期大家在临床中能够结合自身的特点选择最优的阻滞方法，提高该技术的成功率。

Citation： 周莉, 吴超然, 银燕, 杨邦祥. 星状神经节阻滞技术进展. 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.	Ateş 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.	邱卫红, 黄新军. 气管旁入法与高位侧入法行星状神经节阻滞的解剖学比较[J]. 解剖学研究, 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.	赵鹏. 浅谈星状神经节阻滞技术的进展[J]. 重庆医学, 2010, 39(16):2217-2219.
21.	邓兆宏, 孙万群. 星状神经节阻滞入路的应用解剖[J]. 郧阳医学院学报, 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, 汤淑芬, 等. 星状神经节阻滞改良前入路法[J]. 疼痛学杂志, 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.	陈怀. 肌间沟侧入法星状神经节阻滞[J]. 疼痛学杂志, 1996, 4(1):8-9.
30.	吴春友. 改良侧入法星状神经节阻滞[J]. 疼痛学杂志, 1995, 3(2):57.
31.	Malmqvist EL, Bengtsson M, Sörensen J. Effcacy of stellate ganglion block:a clinical study with bupivacaine[J]. Reg Anesth, 1993, 17(6):340-347.
32.	周志华. 颈_6与颈_7横突星状神经节阻滞法的比较[J]. 中国疼痛医学杂志, 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. Ateş 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. 邱卫红, 黄新军. 气管旁入法与高位侧入法行星状神经节阻滞的解剖学比较[J]. 解剖学研究, 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. 赵鹏. 浅谈星状神经节阻滞技术的进展[J]. 重庆医学, 2010, 39(16):2217-2219.
21. 邓兆宏, 孙万群. 星状神经节阻滞入路的应用解剖[J]. 郧阳医学院学报, 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, 汤淑芬, 等. 星状神经节阻滞改良前入路法[J]. 疼痛学杂志, 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. 陈怀. 肌间沟侧入法星状神经节阻滞[J]. 疼痛学杂志, 1996, 4(1):8-9.
30. 吴春友. 改良侧入法星状神经节阻滞[J]. 疼痛学杂志, 1995, 3(2):57.
31. Malmqvist EL, Bengtsson M, Sörensen J. Effcacy of stellate ganglion block:a clinical study with bupivacaine[J]. Reg Anesth, 1993, 17(6):340-347.
32. 周志华. 颈_6与颈_7横突星状神经节阻滞法的比较[J]. 中国疼痛医学杂志, 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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