严重继发性雷诺现象的多学科治疗：1例病例报告

冷翠波; 林冠军; 曹宏; 刘子嘉

doi:10.24920/004078

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严重继发性雷诺现象的多学科治疗：1例病例报告

中国医学科学杂志（英文版） 2022年37卷第4期页码：353-358

Case Report | Updated：2024-04-10

- 严重继发性雷诺现象的多学科治疗：1例病例报告
- Affiliations：
  
  1. 1Department of Anesthesiology, Affiliated Qingdao Central Hospital of Qingdao University & Second Affiliated Hospital of Medical College of Qingdao University, Qingdao, Shandong 266042, China
  2. 2Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China
  3. 3Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
- Author bio：
  
  * 86-18501155710, E-mail: liu-zj02@126.com
- Funds：
- DOI：10.24920/004078
  中图分类号：
- 收稿日期：2022-02-05，
  
  录用日期：2022-4-19，
  
  网络出版日期：2022-04-26，
  
  纸质出版日期：2022-12-31
- Accepted：
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冷翠波, 林冠军, 曹宏, 等. 严重继发性雷诺现象的多学科治疗：1例病例报告[J]. 中国医学科学杂志（英文版）, 2022,37(4):353-358.

Cuibo Leng, Guanjun Lin, Hong Cao, et al. Multidisciplinary Treatment for Severe Secondary Raynaud’s Phenomenon: A Case Report[J]. Chinese medical sciences journal, 2022, 37(4): 353-358.
冷翠波, 林冠军, 曹宏, 等. 严重继发性雷诺现象的多学科治疗：1例病例报告[J]. 中国医学科学杂志（英文版）, 2022,37(4):353-358. DOI： 10.24920/004078.

Cuibo Leng, Guanjun Lin, Hong Cao, et al. Multidisciplinary Treatment for Severe Secondary Raynaud’s Phenomenon: A Case Report[J]. Chinese medical sciences journal, 2022, 37(4): 353-358. DOI： 10.24920/004078.

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1例65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。

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 65-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. The patient responded well to the medication

avoiding amputation or obviously dysfunction. Multidisciplinary team gathering the doctors from different departments proposes appropriate strategies for patients with severe Raynaud’s phenomenon and could improve the prognosis and satisfaction of patient effectively.

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references

Landry GJ . Current medical and surgical management of Raynaud’s syndrome . J Vasc Surg 2013 ; 57 ( 6 ): 1710 - 6 . doi: 10.1016/j.jvs.2013.03.012 https://dx.doi.org/10.1016/j.jvs.2013.03.012 . DOI: 10.1016/j.jvs.2013.03.012 http://doi.org/10.1016/j.jvs.2013.03.012 https://linkinghub.elsevier.com/retrieve/pii/S0741521413005983 https://linkinghub.elsevier.com/retrieve/pii/S0741521413005983

Gayraud M . Raynaud’s phenomenon . Joint Bone Spine 2007 ; 74 ( 1 ): e1 - 8 . doi: 10.1016/j.jbspin.2006.07.002 https://dx.doi.org/10.1016/j.jbspin.2006.07.002 . DOI: 10.1016/j.jbspin.2006.07.002 http://doi.org/10.1016/j.jbspin.2006.07.002 https://linkinghub.elsevier.com/retrieve/pii/S1297319X06002466 https://linkinghub.elsevier.com/retrieve/pii/S1297319X06002466

Chikura B , Moore TL , Manning JB , et al . Sparing of the thumb in Raynaud’s phenomenon . Rheumatology (Oxford) 2008 ; 47 ( 2 ): 219 - 21 . doi: 10.1093/rheumatology/kem353 https://dx.doi.org/10.1093/rheumatology/kem353 . DOI: 10.1093/rheumatology/kem353 http://doi.org/10.1093/rheumatology/kem353

Wigley FM , Flavahan NA . Raynaud’s Phenomenon . N Engl J Med 2016 ; 375 ( 6 ): 556 - 65 . doi: 10.1056/NEJMra1507638 https://dx.doi.org/10.1056/NEJMra1507638 . DOI: 10.1056/NEJMra1507638 http://doi.org/10.1056/NEJMra1507638 http://www.nejm.org/doi/10.1056/NEJMra1507638 http://www.nejm.org/doi/10.1056/NEJMra1507638

Pauling JD , Hughes M , Pope JE . Raynaud’s phenomenon—an update on diagnosis, classification and management . Clin Rheumatol 2019 ; 38 ( 12 ): 3317 - 30 . doi: 10.1007/s10067-019-04745-5 https://dx.doi.org/10.1007/s10067-019-04745-5 . DOI: 10.1007/s10067-019-04745-5 http://doi.org/10.1007/s10067-019-04745-5

Belch J , Carlizza A , Carpentier PH , et al . ESVM guidelines— the diagnosis and management of Raynaud’s phenomenon . Vasa 2017 ; 46 ( 6 ): 413 - 23 . doi: 10.1024/0301-1526/a000661 https://dx.doi.org/10.1024/0301-1526/a000661 . DOI: 10.1024/0301-1526/a000661 http://doi.org/10.1024/0301-1526/a000661

Juche A , Siegert E , Mueller-Ladner U , et al . Reality of inpatient vasoactive treatment with prostacyclin derivatives in patients with acral circulation disorders due to systemic sclerosis in Germany . Z Rheumatol 2020 ; 79 ( 10 ): 1057 - 66 . doi: 10.1007/s00393-019-00743-9 https://dx.doi.org/10.1007/s00393-019-00743-9 . DOI: 10.1007/s00393-019-00743-9 http://doi.org/10.1007/s00393-019-00743-9 https://doi.org/10.1007/s00393-019-00743-9 https://doi.org/10.1007/s00393-019-00743-9

Hughes M , Ong VH , Anderson ME , et al . Consensus best practice pathway of the UK Scleroderma Study Group: digital vasculopathy in systemic sclerosis . Rheumatology (Oxford) 2015 ; 54 ( 11 ): 2015 - 24 . doi: 10.1093/rheumatology/kev201 https://dx.doi.org/10.1093/rheumatology/kev201 . DOI: 10.1093/rheumatology/kev201 http://doi.org/10.1093/rheumatology/kev201

Rinkinen J , Halvorson EG . Topical vasodilators in microsurgery: what is the evidence ? J Reconstr Microsurg 2017 ; 33 ( 1 ): 1 - 7 . doi: 10.1055/s-0036-1592191 https://dx.doi.org/10.1055/s-0036-1592191 . DOI: 10.1055/s-0036-1592191 http://doi.org/10.1055/s-0036-1592191

Ma Q , Liu D , Gong R , et al . Mechanically induced vasospasm-evaluation of spasmolytic efficacy of 10 pharmaceutical agents using laser speckle contrast imaging . Lasers Surg Med 2021 ; 53 ( 5 ): 684 - 94 . doi: 10.1002/lsm.23347 https://dx.doi.org/10.1002/lsm.23347 . DOI: 10.1002/lsm.23347 http://doi.org/10.1002/lsm.23347

Vargas CR , Iorio ML , Lee BT . A systematic review of topical vasodilators for the treatment of intraoperative vasospasm in reconstructive microsurgery . Plast Reconstr Surg 2015 ; 136 ( 2 ): 411 - 22 . doi: 10.1097/PRS.0000000000001431 https://dx.doi.org/10.1097/PRS.0000000000001431 . DOI: 10.1097/PRS.0000000000001431 http://doi.org/10.1097/PRS.0000000000001431

Andrigueti FV , Ebbing PCC , Arismendi MI , et al . Evaluation of the effect of sildenafil on the microvascular blood flow in patients with systemic sclerosis: a randomised, double-blind, placebo-controlled study . Clin Exp Rheumatol 2017 ; 106 ( 4 ): 151 - 8 .

Hachulla E , Hatron PY , Carpentier P , et al . Efficacy of sildenafil on ischaemic digital ulcer healing in systemic sclerosis: the placebo-controlled SEDUCE study . Ann Rheum Dis 2016 ; 75 ( 6 ): 1009 - 15 . doi: 10.1136/annrheumdis-2014-207001 https://dx.doi.org/10.1136/annrheumdis-2014-207001 . DOI: 10.1136/annrheumdis-2014-207001 http://doi.org/10.1136/annrheumdis-2014-207001

Sahin OF , Tarikci Kilic E , Aksoy Y , et al . The importance of perfusion index monitoring in evaluating the efficacy of stellate ganglion blockage treatment in Raynaud’s disease . Libyan J Med 2018 ; 13 ( 1 ): 1422666 . doi: 10.1080/19932820.2017.1422666 https://dx.doi.org/10.1080/19932820.2017.1422666 . DOI: 10.1080/19932820.2017.1422666 http://doi.org/10.1080/19932820.2017.1422666

Vegas DH , Fabiani MA , Gonzalez-Urquijo M , et al . Novel combined approach for digital necrosis secondary to Raynaud’s phenomenon . Vasc Endovascular Surg 2021 ; 55 ( 7 ): 766 - 71 . doi: 10.1177/15385744211005663 https://dx.doi.org/10.1177/15385744211005663 . DOI: 10.1177/15385744211005663 http://doi.org/10.1177/15385744211005663 http://journals.sagepub.com/doi/10.1177/15385744211005663 http://journals.sagepub.com/doi/10.1177/15385744211005663

Isei T , Abe M , Nakanishi T , et al . The wound/burn guidelines-3: guidelines for the diagnosis and treatment for diabetic ulcer/gangrene . J Dermatol 2016 ; 43 ( 6 ): 591 - 619 . doi: 10.1111/1346-8138.13285 https://dx.doi.org/10.1111/1346-8138.13285 . DOI: 10.1111/1346-8138.13285 http://doi.org/10.1111/1346-8138.13285 http://doi.wiley.com/10.1111/jde.2016.43.issue-6 http://doi.wiley.com/10.1111/jde.2016.43.issue-6

Thom SR . Hyperbaric oxygen: its mechanisms and efficacy . Plast Reconstr Surg 2011 ; 127 ( Suppl 1 ): 131 S- 41 S. doi: 10.1097/PRS.0b013e3181fbe2bf https://dx.doi.org/10.1097/PRS.0b013e3181fbe2bf . DOI: 10.1097/PRS.0b013e3181fbe2bf http://doi.org/10.1097/PRS.0b013e3181fbe2bf http://journals.lww.com/00006534-201101000-00018 http://journals.lww.com/00006534-201101000-00018

Howard MA , Asmis R , Evans KK , et al . Oxygen and wound care: a review of current therapeutic modalities and future direction . Wound Repair Regen 2013 ; 21 ( 4 ): 503 - 11 . doi: 10.1111/wrr.12069 https://dx.doi.org/10.1111/wrr.12069 . DOI: 10.1111/wrr.12069 http://doi.org/10.1111/wrr.12069

Sato T , Arai K , Ichioka S . Hyperbaric oxygen therapy for digital ulcers due to Raynaud’s disease . Case Reports Plast Surg Hand Surg 2018 ; 5 ( 1 ): 72 - 4 . doi: 10.1080/23320885.2018.1525684 https://dx.doi.org/10.1080/23320885.2018.1525684 . DOI: 10.1080/23320885.2018.1525684 http://doi.org/10.1080/23320885.2018.1525684

Herrick A , Muir L . Raynaud’s phenomenon (secondary) . BMJ Clin Evid 2014; 2014 : 1125 .

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