星状神经节阻滞治疗重症破伤风难治性交感神经风暴：一例病例报告

文献信息

中文摘要

背景： 重症破伤风需要大剂量镇静药和镇痛药。然而，常规药物治疗有限，尤其是当疾病并发交感神经风暴时。在此，我们报告一例重症破伤风并发难治性交感神经风暴，经超声引导星状神经节阻滞（SGB）成功终止。SGB可作为这一危及生命的自主神经并发症的有价值挽救治疗，在标准内科治疗失败时提供可能有效的治疗选择。
病例报告： 一名67岁男性因左手中指被竹签刺伤后数日出现进行性症状而就诊于我院。异物在自行取出前已留存3天，之后未接受任何系统性医疗处理。他随后出现颈部僵硬、吞咽困难、苍白和发绀，导致住院。入院时，急诊处理包括气管插管、伤口清创以及给予破伤风类毒素疫苗和人破伤风免疫球蛋白。然而，标准镇静药、镇痛药和肌肉松弛药的联合方案不足以控制反复抽搐和交感神经风暴。因此实施了超声引导下左侧SGB，有效终止了交感神经风暴。
结论： 对于尽管接受标准治疗仍表现出难治性交感神经过度活跃的重症破伤风患者，SGB可能具有挽救生命或临床价值。然而，该干预措施的因果关系和普遍适用性需要通过更多临床研究进一步验证。

英文摘要

BACKGROUND Severe tetanus necessitates high-dose sedatives and analgesics. However, conventional pharmacotherapy is limited, particularly when the disease is complicated by a sympathetic storm. Herein, we report a case of severe tetanus complicated by a refractory sympathetic storm that was successfully aborted with ultrasound-guided stellate ganglion block (SGB). SGB can be a valuable rescue therapy for this life-threatening autonomic complication, offering a potentially effective therapeutic option when standard medical management fails. CASE REPORT A 67-year-old man presented to our hospital with a several-day history of progressive symptoms following a puncture wound to the middle finger of his left hand caused by a bamboo skewer. The foreign body had remained embedded for 3 days before being self-removed by the patient, without any subsequent systematic medical treatment. He subsequently developed neck stiffness, dysphagia, pallor, and cyanosis, leading to hospital admission. Upon admission, emergency management included endotracheal intubation, wound debridement, and administration of tetanus toxoid vaccine and human tetanus immunoglobulin. However, the combination of standard sedatives, analgesics, and muscle relaxants proved insufficient to control recurrent convulsions and sympathetic storm. An ultrasound-guided left SGB was therefore performed, which effectively aborted the sympathetic storm. CONCLUSIONS SGB can offer life-saving potential or clinical value for patients with severe tetanus who exhibit refractory sympathetic hyperactivity despite standard treatment. However, the causal relationship and general applicability of this intervention require further validation through additional clinical studies.