2019 年第 12 期 第 14 卷

星状神经节阻滞对痉挛型单侧脑瘫患儿颈动脉外膜剥脱术后康复效果的影响

Effect of stellate ganglion block on postoperative rehabilitation of carotid artery adventitia removal in children with unilateral spastic cerebral palsy

作者：袁应川栾新平闫宝锋

英文作者：

单位：830063乌鲁木齐，新疆医科大学第二附属医院脑瘫中心

英文单位：

关键词：痉挛型单侧脑瘫；颈动脉外膜剥脱术；星状神经节阻滞

英文关键词：

• 摘要：

• 【摘要】目的    探讨星状神经节阻滞对于经颈动脉外膜剥脱术治疗的痉挛型单侧脑瘫患儿康复效果的影响。方法    选取2016年9月1日至2018年9月1日在新疆医科大学第二附属医院行颈动脉外膜剥脱术的痉挛型单侧脑瘫患儿65例，完全随机分为对照组（31例）和阻滞组（34例）。对照组术后每周进行康复功能训练；阻滞组在对照组基础上每周进行1次对侧星状神经节阻滞治疗。2组患儿术前、术后1周、术后6个月进行患侧局部脑血流灌注加权成像（PWI）、磁共振波谱成像（MRS）检查，并评估精细运动功能评定量表（FMFM）和粗大运动功能测试量表（GMFM-66）评分。结果    术后6个月，阻滞组患侧PWI检查额叶、中央前回、基底核、丘脑区域脑血流值明显高于对照组［（68.6±4.3）ml/(min·100 g)比（64.7±5.2）ml/(min·100 g)、（54.9±3.4）ml/(min·100 g)比（46.2±2.4）ml/(min·100 g)、（22.3±5.0）ml/(min·100 g)比（19.7±5.4）ml/(min·100 g)、（36.1±4.3）ml/(min·100 g)比（33.4±3.7）ml/(min·100 g)］，差异均有统计学意义（均P＜0.05）。术后6个月，阻滞组患侧基底核和丘脑MRS代谢物峰高比率测定结果提示，阻滞组N-乙酰天门冬氨酸/胆碱化合物和N-乙酰天门冬氨酸/肌酸峰高比率明显高于对照组［（0.70±0.09）比（0.60±0.09）、（1.13±0.17）比（1.03±0.10）］，差异均有统计学意义（均P＜0.05）。术后6个月，阻滞组FMFM评分和GMFM-66评分均明显高于对照组［（80±12）分比（74±11）分、（88±7）分比（83±6）分］，差异均有统计学意义（均P＜0.05）。结论    星状神经节阻滞治疗能够改善痉挛型单侧脑瘫患儿颈动脉外膜剥脱术后患侧大脑部分脑区血液供应情况，缓解患儿肢体痉挛，进一步改善患儿运动功能。

• 【Abstract】Objective    To investigate the effect of stellate ganglion block on the rehabilitation of children with unilateral spastic cerebral palsy after carotid artery adventitia removal. Methods    Sixty-five children with unilateral spastic cerebral palsy who underwent carotid artery adventitia removal in the Second Affiliated Hospital of Xinjiang Medical University from September 1st, 2016 to September 1st, 2018 were randomly divided into control group（31 cases） and block group（34 cases）. The control group had routine rehabilitation and function training after surgery. The block group was treated with stellate ganglion block once a week on the basis of routine therapy. Local cerebral blood flow perfusion weighted imaging（PWI） and magnetic resonance spectrum（MRS） examination were performed before, 1 week and 6 months after surgery. Recovery of athletic ability was evaluated by Fine Motor Function Measure（FMFM） and Gross Motor Function Measure（GMFM-66）. Results    Six months after surgery, blood flow measured by PWI of frontal lobe, central anterior gyrus, basal ganglia and thalamus in block group were significantly higher than those in control group［（68.6±4.3）ml/(min·100 g) vs （64.7±5.2）ml/(min·100 g), （54.9±3.4）ml/(min·100 g) vs （46.2±2.4）ml/(min·100 g), （22.3±5.0）ml/(min·100 g) vs （19.7±5.4）ml/(min·100 g), （36.1±4.3）ml/(min·100 g) vs （33.4±3.7）ml/(min·100 g)］（all P＜0.05）. Peak-to-peak ratios of N-acetylaspartic acid to choline compounds and N-acetylaspartic acid to creatine measured by MRS of basal ganglia and thalamus in block group were significantly higher than those in control group［（0.70±0.09） vs （0.60±0.09）, （1.13±0.17） vs （1.03±0.10）］（both P＜0.05）. Scores of FMFM and GMFM-66 in block group were significantly higher than those in control group［（80±12） vs （74±11）, （88±7） vs （83±6）］（both P＜0.05）. Conclusion    Stellate ganglion block can improve blood supply to partial brain regions, relieve limb spasm and improve motor function in children with unilateral spastic cerebral palsy treated by carotid artery adventitia removal.