星状神经节阻滞治疗失眠症的临床观察

发布时间：2017-12-31 01:12

  本文关键词：星状神经节阻滞治疗失眠症的临床观察　出处：《苏州大学》2015年硕士论文　论文类型：学位论文

  更多相关文章： 星状神经节阻滞 失眠症 利多卡因

【摘要】：目的通过对选择较低浓度的0.5%利多卡因行星状神经节阻滞治疗失眠和口服艾司唑仑药物治疗失眠进行对比研究,以期为临床上更为安全、有效地治疗失眠症提供新的临床依据。方法根据《中国成人失眠诊断与治疗指南》的诊断标准,选择短期性失眠症患者共40例,入组患者均无出血倾向及严重心血管疾病。随机分成对照组(结合患者体重以及耐药性情况,采用艾司唑仑每日睡前30分钟1mg、2mg、4mg三种不同剂量口服,剂量标准以患者夜间睡眠能达到自我满意程度的最小剂量为准)和治疗组(选用较低浓度的0.5%利多卡因5ml行星状神经节阻滞)。二组治疗均为每日一次,星状神经节阻滞为左右两侧交替进行,治疗周期为10天,两组患者均辅以相同的睡眠卫生教育。治疗前两组患者均行匹兹堡睡眠质量指数(PSQI)量表评测睡眠情况,治疗结束后一月进行随访,复测PSQI量表。比较两组患者治疗前后PSQI量表七个组成因子的分值和总分的评分变化,以及睡眠时间的变化。因神经阻滞的特殊性,治疗组治疗期间均采用心电监护仪监测患者心率、血压、指末血氧饱和度。结果观察1治疗结果治疗后两组患者睡眠时间均有延长,睡眠质量均有所提高。经独立样本t检验分析,治疗组在睡眠质量、催眠药物依赖性、白天功能紊乱以及PSQI总分方面均优于对照组(P0.05),有统计学意义。2治疗疗效两组患者年龄、性别、体重、治疗时间等比较无明显差异。治疗前两组患者PSQI量表评分无明显差异。疗效评估:①痊愈:PSQI总分为≤2,每晚平均睡眠时间6h,日间功能自我感觉良好。②显效:PSQI为3~5分,每晚平均睡眠时间5~6h,日间功能感觉较好。③有效:PSQI为6~7分,睡眠时间4~5h,日间功能感觉尚可。④无效:与治疗前无变化。随访结果表明:对照组治愈3例,显效5例,好转6例,无效6例,总有效率为70%;治疗组治愈4例,显效7例,好转6例,无效3例,总有效率为85.0%,与对照组相比,经卡方检验,无显著性差异(P0.05)。因此,予0.5%利多卡因行星状神经节阻滞治疗失眠可取得不亚于口服药物的疗效。在疗效方面,治疗组的有效率有提高的趋势。统计学无明显差异,可能与本实验中样本病例数量过少有关。3血流动力学治疗组行神经阻滞前后均应用心电监护仪监测HR、BP、SPO2。结果表明,治疗组患者在治疗前后血流动力学指标均在正常波动范围之内,阻滞前后数据经配对t检验,无显著性差异(P0.05)。结论1予0.5%利多卡因行星状神经节阻滞治疗短期性失眠疗效与口服药物无明显差异。予0.5%利多卡因行星状神经节阻滞治疗能有效改善患者睡眠质量,并改善患者日间功能。2予0.5%利多卡因行星状神经节阻滞对患者血流动力学无显著影响,安全可靠。
[Abstract]:Objective to compare the choice of 0.5% lidocaine planetary ganglion block in the treatment of insomnia and oral eszolam in the treatment of insomnia in order to be more safe in clinic. Methods according to the diagnostic criteria of Chinese Adult Insomnia diagnosis and treatment guidelines, 40 patients with short-term insomnia were selected. All the patients in the study group had no tendency to bleed and severe cardiovascular disease. They were randomly divided into two groups: the control group (combined with the weight and drug resistance of the patients, 1 mg / day before sleep 30 minutes before sleep). Three different doses of 4 mg were taken orally. The dose standard was based on the minimum dose of self-satisfaction achieved by night sleep) and the treatment group (0.5% lidocaine 5ml planetary ganglion block at lower concentration). The two groups were treated once a day. Stellate ganglion block was performed alternately on the left and right sides and the treatment period was 10 days. The patients in both groups were given the same sleep hygiene education. Before treatment, the patients in both groups were assessed with Pittsburgh Sleep quality Index (PSQI) and followed up on January. Retest PSQI scale. Compare the scores of seven constituent factors and total score of PSQI scale before and after treatment, as well as the change of sleep time, because of the particularity of nerve block. In the treatment group, ECG monitor was used to monitor the heart rate, blood pressure and end-point oxygen saturation. Results 1 the sleep time of the two groups was prolonged after treatment. The sleep quality of the treatment group was better than that of the control group in terms of sleep quality, hypnotic drug dependence, daytime dysfunction and total score of PSQI (P 0.05). There were significant differences in age, sex and weight between the two groups. There was no significant difference in treatment time between the two groups before treatment. There was no significant difference in the scores of PSQI scale between the two groups before treatment. The total score of 1: 1 recovery was 鈮，

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