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題 名 | Cholecystitis after Repeated Sympathetic Blocks for Post-herpetic Neuralgia=以交感神經阻斷術治療帶狀疱疹後神經痛併發膽囊發炎--病例報告 |
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作 者 | 何菊修; 李明哲; 石明煌; | 書刊名 | 慈濟醫學 |
卷 期 | 17:4 民94.08 |
頁 次 | 頁257-259+299 |
分類號 | 416.5 |
關鍵詞 | 膽結石; 交感神經阻斷術; 疼痛; Gallstones; Sympatholysis; Pain; |
語 文 | 英文(English) |
中文摘要 | 帶狀疱疹後神經痛的發生率會隨年齡而增加,口服藥物仍是主要的治療方式,發病早期或口服藥物效果不佳時可能採用交感神經阻斷術。本病例報告是一位79歲男性病人,兩個月前發生急性炎狀疱疹,皮節分布在第八和第十一胸椎之間,帶之後發生疹後神經痛,疼痛部位有色素沈著及輕微結痂,病兆部位有麻痛及刺痛感,但無觸痛感,疼痛指數界於5和6之間,且因疼痛有嚴重失眠及輕生念頭。由於之前的口服藥物效果不佳,經評估後改為每天接受8毫升0.45% Ropivacaine硬膜外交感神經阻斷術,連續四天注射之後反應良好,疼痛指數降為2左右,睡眠狀況良好。第五天病人發現右上腹疼痛,但疼痛形態和原來不同,以悶痛為主,Murphy氏徵象為陰性,但腹部超音波檢查發現有三顆膽結石,一週後病人接受腹腔鏡膽囊摘除術,術後病人上腹悶痛解除,但仍因輕微麻痛接受口服三環抗憂鬱症藥物治療11個月後停藥。我們推測,連續性交感神經阻斷術對於膽囊結石病人可能引發膽囊發炎,並強調疼痛型態改變時併發其他原因疼痛之可能性。 |
英文摘要 | Postherpetic neuralgia (PHN) is associated with increasing age. Medications are the mainstay of treatment. Sympathetic nerve bocks are performed in the early phase or when the response to medication is poor. We report on a 79-year-old man with PHN on the right side with a T8 to T11 dermatomal distribution. The patient experienced dysesthesia and aching in the involved area. The verbal analog score (VAS) was 5-6 on a 0-10 digit scale. The patient also suffered from severe sleep disturbance and thoughts of death due to insomnia. Treatment with repeated epidural sympathetic nerve blocks was satisfactory with a VAS of 0-3. However, vague right subcostal pain developed after the interventions. An abdominal echogram revealed 3 gallstones in the gall bladder. A laparoscopic cholecystectomy was performed a week later. After the operation, the patient received medication for the mild dyses-thetic pain for another 11 months with complete remission. We propose that potential complications can occur when sympathetic nerve blocks are used in a patient with preexisting gallstones. We also emphasize the possibility of another etiology when there is a change of the character of pain. |
本系統中英文摘要資訊取自各篇刊載內容。