<br>超声引导下近端肋间阻滞交感神经阻滞对电风暴患者的安全性和有效性,JACC: Clinical Electrophysiology

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超声引导下近端肋间阻滞交感神经阻滞对电风暴患者的安全性和有效性
JACC: Clinical Electrophysiology ( IF 8.0 ) Pub Date : 2024-01-31 , DOI: 10.1016/j.jacep.2023.12.006
Uyanga Batnyam ₁ , Kamen V Vlassakov ₂ , Ahmad Halawa ₁ , Erica Seligson ₂ , ₂ , Liting Chen ₃ , Brahim Redouane ₁ , David Janfaza ₂ , Usha B Tedrow ₁

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标准治疗失败的电风暴（ES）患者死亡率很高。先前的研究报告了床边超声引导下经皮星状神经节阻滞（SGB）对 ES 的有效治疗。我们报告了通过一种新的替代方法进行交感神经阻滞的经验：近端肋间阻滞（PICB）。与 SGB 相比，该技术针对的是通常没有其他导管和支持装置的区域，并且可能对抗凝中断的要求不那么严格，并且局灶性神经副作用的风险也较低。作者试图描述 PICB 在难治性 ES 患者中的安全性和有效性。我们回顾了 2018 年 1 月至 2023 年 2 月期间接受 PICB 的 ES 患者的机构数据，以分析手术安全性以及短期和长期结果。在此期间共有15名连续ES患者接受了PICB治疗。其中，11 名患者 (73.3%) 维持单独 PICB，4 名患者 (26.6%) 维持 SGB 和 PICB 联合阻滞。总体而言，仅 PICB 维持的 72.7% 患者和双侧 PICB 维持的 77.8% 患者具有出色的心律失常抑制效果。 PICB 后，植入式心律转复除颤器治疗显着减少 (<0.05)，接受 PICB 的患者中有 93.3% 在出院或心脏移植之前未出现植入式心律转复除颤器休克。所有患者均继续抗凝治疗，没有出现与手术相关的并发症。除了 3 名患者出现轻度短暂神经症状外，未观察到明显的神经或血流动力学后遗症。对于难治性 ES 患者，连续 PICB 提供安全有效的交感神经阻滞 (77.8% 室性心律失常抑制），无需中断抗凝即可实现，且无明显副作用。

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Safety and Efficacy of Ultrasound-Guided Sympathetic Blockade by Proximal Intercostal Block in Electrical Storm Patients

Electrical storm (ES) patients who fail standard therapies have a high mortality rate. Previous studies report effective management of ES with bedside, ultrasound-guided percutaneous stellate ganglion block (SGB). We report our experience with sympathetic blockade administered via a novel alternative approach: proximal intercostal block (PICB). Compared with SGB, this technique targets an area typically free of other catheters and support devices, and may pose less strict requirements for anticoagulation interruption, along with lower risk of focal neurological side effects. The authors sought to describe the safety and efficacy of PICB in patients with refractory ES. We reviewed our institutional data on ES patients who underwent PICB between January 2018 and February 2023 to analyze procedural safety and short- and long-term outcomes. A total of 15 consecutive patients with ES underwent PICB during this period. Of those, 11 patients (73.3%) were maintained on PICB alone, and 4 patients (26.6%) were maintained on combined block with SGB and PICB. Overall, 72.7% patients who were maintained on PICB alone and 77.8% patients who were maintained on bilateral PICB had excellent arrhythmia suppression. After PICB, implantable cardioverter-defibrillator therapies were significantly reduced ( < 0.05), with 93.3% of patients receiving PICB having no implantable cardioverter-defibrillator shock until discharge or heart transplant. Anticoagulation was continued in all patients and there were no procedure-related complications. Apart from mild transient neurological symptoms seen in 3 patients, no significant neurological or hemodynamic sequelae were observed. In patients with refractory ES, continuous PICB provided safe and effective sympathetic block (77.8% ventricular arrhythmia suppression), achievable without interruption of anticoagulation, and without significant side effects.

更新日期：2024-01-31

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