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Stellate ganglion block phrenic nerve block treatment of 28 cases of intractable hiccups

Author: Anonymous From: www.yourpaper.net Posted: 2010-06-24 10:07:21 Read:
Author: Li Xiaoqiang, Zhi-Wu Liu, quarter zhenpeng
[keyword] stellate ganglion block phrenic nerve block intractable hiccups
Hiccups, also known as spasm of the diaphragm, the diaphragm by a variety of causes involuntary paroxysmal regularity of contraction due to neurological disorders, intractable hiccups with its frequent hiccups, persistent symptoms, duration of more than 48 hours, the general treatment invalid, resulting in mental distress of patients sicker. Our hospital in June 2003 - June 2009 stellate ganglion block joint phrenic nerve block treatment of 28 cases of intractable hiccups, and achieved satisfactory results. Are as follows.
Materials and Methods
1.1 General information on this group of patients with intractable hiccups of 28 cases before treatment, after drugs, acupuncture treatment is invalid, the symptoms persist for more than 24 hours, including 26 males and 2 females, aged 20 to 68 years, the history of the longest 46 days. The autonomic dysfunction hiccups in 10 cases, 12 cases of inflammation of the abdominal organs or abdominal surgery after due reflection hiccup, drug-induced hiccups in 3 cases, traumatic brain injury, cerebral thrombosis due to central hiccups three cases.
1.2 The treatment of all patients into the operating room stellate ganglion block, phrenic nerve block, regular fasting, water 8h, monitoring heart rate, respiration, blood pressure, blood oxygen saturation and other vital signs, ready laryngoscope tracheal catheter and first-aid equipment and medicines. The same side of the first stellate ganglion block plus the phrenic nerve block, intravenous droperidol 5mg, close observation of vital signs. 1.5h then contralateral stellate ganglion block phrenic nerve block, observed 1h adverse reactions out of the operating room.
1.2.1 stellate ganglion block the patient supine, as the head forward. With a thin pillows shoulders below the neck stretching as far as possible. Surface Location: along the upper edge of the sternoclavicular joint clavicle inward to touch the outer edge of the trachea, and then along the trachea up 3 ~ 4cm, parallel to the outer edge of the trachea hit arterial pulse. Patients who use the left middle finger sternocleidomastoid and carotid sheath contents pressure to the outside of the tip of the middle finger pressure palpable the bone feel, move the middle finger and held it up to the outer edge of the trachea slightly outward and inward as far as possible, expose gap puncture site. After routine disinfection, 3cm long, the 7 short needle along surgeon fingertips vertical feed needle 1.5cm, until the tip touches the bone, indicating that the tip touches the neck or neck of the root of the transverse process, and then the tip exit 1 ~ 2min, carefully suck-back no blood or cerebrospinal fluid injection of 1% lidocaine 8 ~ 10ml. 2 to 3 minutes after injection the patient developed ipsilateral Horner levy, it indicates that a successful block. The tip touched transverse process the patient does not appear paresthesia, obesity and crude short-necked patients, it may be as deep as 2.5 to about 3 cm. If you find the needle deeper than this, it is possible to tip pierce between the two transverse process. The needle should immediately exit, and then adjust the needle tip to puncture the cranial or caudal direction, until the tip touches the transverse process bone feeling [1]. 1.2.2 phrenic nerve block the patient to the the pillow supine position, head turned to the contralateral. Surface Location: the patient looked up, to expose the posterior border of sternocleidomastoid is easy to determine the posterior border of sternocleidomastoid before the scalene gap, and this gap supraclavicular, 2.5 to 3cm at doing a marker at the puncture site. After routine disinfection with 1% lidocaine Picchu, patients who use the left thumb and index finger to lift the sternocleidomastoid, right then 3cm long 7 short needle along the sternocleidomastoid and anterior scalene muscle clearance groove puncture. Wear depth of about 2.5 to 3cm feel the needle tip to pierce the superficial fascia and the emergence of the gas injection loss of resistance, immediately stop the needle, suck-back no blood, no gas, no cerebrospinal fluid injection of 1% lidocaine 8 ~ 10ml. Close observation of the patient's breathing changes after injection [1].
2 results
28 patients after the first treatment the hiccups disappeared in 22 cases, of which disappeared in 6 patients out of the operating room the next day after getting up early hiccups disappeared in 16 patients. More than six cases of hiccups significant improvement in symptoms the hiccups disappeared completely after the next day for the second treatment (the same way the first time).
discussion
Intractable hiccups is generally believed that the vagus nerve reflex or phrenic nerve is stimulated, the diaphragm and the intercostal muscles involuntary synchronization suddenly shrink about 30ms with glottal closure, which occurred in a special oxygen and discomfort. Spasm of the diaphragm incentives mood, diet, drugs, surgical stimulation. A variety of treatment, but the effects vary, patients often painful. Stellate ganglion block treatment of intractable hiccups, the mechanism may be spread by the drug, blocking the the cervicothoracic sympathetic preganglionic and postganglionic fibers, inhibiting the effects of the sympathetic innervation of the tissues and organs of sympathetic activity, interfere with the phrenic nerve impulses also conditioning the hypothalamus and autonomic functions, and improve the state due to autonomic dysfunction caused by spasm of the diaphragm. Phrenic nerve block for the treatment of intractable hiccups mainly by blocking the hiccup reflex arc, reduce the phrenic nerve stress, to achieve the purpose of termination of hiccups. The droperidol limbic system, central inhibitors of the hypothalamus and network structure. It is through the inhibition of the ascending reticular activating system, the hiccup reflex arc decrease the excitability of the nerve and the role of anti-hiccup. Stellate ganglion block plus phrenic nerve block from multiple links to interrupt the vicious cycle of intractable hiccups, the diaphragm restore the regularity of systolic and diastolic, stable mood, relieve mental stress caused to patients, so that the The therapeutic effect is significant and lasting. Also note Withdrawing before injection and injection must ensure that no blood, no solution, no gas, non-bilateral block. The method of treatment of intractable hiccups significant effect is worthy of further study.
[References]
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