Chinese Medical Sciences Journaldoi: 10.24920/004078

• 病例报告 •    下一篇

严重继发性雷诺现象的多学科治疗:1例病例报告

冷翠波1,林冠军2,曹宏1,刘子嘉3*   

  1. 1青岛大学附属青岛市中心医院(青岛大学第二临床医学院)麻醉科,青岛 266042

    2青岛大学附属医院心血管外科,青岛 266000

    3中国医学科学院 北京协和医学院,北京协和医院麻醉科,北京 100730

Multidisciplinary Treatment for Severe Secondary Raynaud’s Phenomenon: A Case Report

Cuibo Leng1, Guanjun Lin2, Hong Cao1, Zijia Liu3*   

  1. 1Department of Anaesthesiology, The Affiliated Qingdao Central Hospital of Qingdao University (The Second Affiliated Hospital of Medical College of Qingdao University) , Qingdao 266042, China

    2Department of Cardiovascular Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266000, China

    3Department of Anaesthesiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China

摘要: 摘要 雷诺现象是指在寒冷或其他交感刺激因素的诱发下,出现间歇性指端缺血的特征性病变。继发性雷诺现象通常症状更为严重,甚至可导致指端溃疡,治疗也尤为复杂。我们报道了165岁女性因继发于亚临床甲状腺功能减退而出现严重的继发性雷诺现象,发作持续时间超过6小时。患者合并有甲状腺功能减退、癫痫、右中指及环指继发性软组织感染。经过多学科会诊与讨论,通过扩张血管、抗凝、甲状腺素替代、星状神经节阻滞、高压氧治疗及清创术等综合治疗,患者顺利康复,避免了截肢和明显的指端功能障碍。多学科诊疗模式(MDT)集合了各学科的专科力量,能为严重继发性雷诺现象患者提供最优治疗策略,可有效改善继发性雷诺现象患者的预后和满意度。

关键词: 继发性雷诺现象, 多学科, 星状神经节阻滞

Abstract: Abstract   Raynaud's phenomenon is a symptom complex manifested as intermittent fingertip ischemia caused by cold or other sympathetic drivers. Secondary Raynaud's phenomenon is often more severe and could even lead to finger ulceration, making it particularly complicated to treat. We describe a case of severe Raynaud's phenomenon secondary to subclinical hypothyroidism lasting for more than 6 hours in a mid-60-year- old woman. The patient was also diagnosed with hypothyroidism, epilepsy, and secondary soft tissue infection of the right middle and ring fingers. After careful multidisciplinary consultation and discussion, the patient received vasodilation, anticoagulation, thyroxine supplementation, stellate ganglion block, hyperbaric oxygen therapy and debridement. Finally, the female patient responded well, avoiding amputation or obviously dysfunction. Multidisciplinary team  gathering the doctors from different departments may propose an appropriate strategy for patients with severe Raynaud's phenomenon  and could improve the prognosis and satisfaction of patient effectively.

Key words: secondary Raynaud's phenomenon, multidisciplinary; stellate ganglion block

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