2018 年第 11 期 第 13 卷

星状神经节阻滞对腹腔镜胆囊切除术患者血流动力学和神经内分泌功能的影响

Effect of stellate ganglion block on hemodynamics and neuroendocrine function in patients undergoing laparoscopic cholecystectomy

作者：訾聪娜滕金亮马先樊娟李福龙

英文作者：

单位：075000河北省张家口市，河北北方学院附属第一医院麻醉科（訾聪娜、滕金亮、樊娟、李福龙），检验科（马先）

英文单位：

关键词：腹腔镜胆囊切除术；星状神经节阻滞；血流动力学；神经内分泌；术后神经功能障碍

英文关键词：

• 摘要：

• 【摘要】目的    探究星状神经节阻滞（SGB）对腹腔镜胆囊切除术患者血流动力学和神经内分泌功能的影响。方法    选择2016年3月至2017年3月于河北北方学院附属第一医院择期行腹腔镜胆囊切除术的80例患者作为研究对象。按照随机数字表法分为SGB组与对照组，每组40例。SGB组术前30 min于右侧C6横突前结节的根部给予8 ml 1%利多卡因；对照组给予等量0.9%氯化钠注射液；分别于患者入室后基础状态（T0）、气管插管即刻（T1）、气腹建立后即刻（T2）、胆囊切除后即刻（T3）、拔管后即刻（T4）测定平均动脉压（MAP）、心率、血氧饱和度（SpO2）等血流动力学指标及肾素、血管紧张素Ⅱ（Ang-Ⅱ）、醛固酮等神经内分泌指标，于术前1 d及术后3、7 d通过简易智力状态检查量表（MMSE）评估患者认知功能。结果    T1～T4时，SGB组MAP、心率明显低于对照组，波动幅度明显小于对照组，差异均有统计学意义（均P<0.05）。2组患者T1～T4各时点肾素、Ang-Ⅱ及醛固酮均较T0时明显降低，且SGB组低于对照组［T1：（0.76±0.14）μg/L比（0.83±0.08）μg/L、（255±62）ng/L比（287±58）ng/L、（101±23）ng/L比（109±27）ng/L；T2：（0.68±0.17）μg/L比（0.78±0.21）μg/L、（240±55）ng/L比（261±50）ng/L、（95±30）ng/L比（103±21）ng/L；T3：（0.55±0.20）μg/L比（0.63±0.18）μg/L、（217±45）ng/L比（246±51）ng/L、（91±30）ng/L比（94±23）ng/L；T4：（0.62±0.09）μg/L比（0.76±0.19）μg/L、（248±62）ng/L比（265±59）ng/L、（112±23）ng/L比（119±25）ng/L］，差异均有统计学意义（均P<0.05）。术后3、7 d 2组患者MMSE评分较术前1 d明显降低，但SGB组高于对照组，差异均有统计学意义（均P<0.05）。结论    SGB可降低神经内分泌水平，维持术中血流动力学稳定，缓解术后神经功能障碍症状。

• 【Abstract】Objective    To investigate the effect of stellate ganglion block(SGB) on hemodynamics and neuroendocrine function in patients undergoing laparoscopic cholecystectomy. Methods    Eighty patients undergoing elective laparoscopic cholecystectomy from March 2016 to March 2017 in the First Affiliated Hospital of Hebei North University were randomly divided into SGB group and control group, with 40 cases in each group. The SGB group was given 8 ml 1% lidocaine and the control group was given same dose of 0.9% sodium chloride injection at the root of right C6 anterior transverse nodule 30 min before operation. Hemodynamic parameters such as mean arterial pressure(MAP), heart rate(HR), blood oxygen saturation(SpO2) and neuroendocrine indicators such as renin, angiotensin Ⅱ(Ang-Ⅱ) and aldosterone were determined in basal state before anesthesia induction(T0), during endotracheal intubation(T1), after establishment of pneumoperitoneum(T2), at the end of cholecystectomy(T3) and extubation(T4). Cognitive function was assessed by Mini-Mental State Examination(MMSE) at 1 d before and 3, 7 d after operation. Results    During T1-T4, MAP and HR in the SGB group were significantly lower than those in the control group(P<0.05). Plasma renin, Ang-Ⅱ and aldosterone at T1-T4 were significantly lower than those at T0; the levels in the SGB group were significantly lower than those in the control group［T1:（0.76±0.14）μg/L vs （0.83±0.08）μg/L, （255±62）ng/L vs （287±58）ng/L, （101±23）ng/L vs （109±27）ng/L; T2:（0.68±0.17）μg/L vs （0.78±0.21）μg/L, （240±55）ng/L vs （261±50）ng/L, （95±30）ng/L vs （103±21）ng/L; T3:（0.55±0.20）μg/L vs （0.63±0.18）μg/L, （217±45）ng/L vs （246±51）ng/L, （91±30）ng/L vs （94±23）ng/L; T4: （0.62±0.09）μg/L vs （0.76±0.19）μg/L, （248±62）ng/L vs （265±59）ng/L, （112±23）ng/L vs （119±25）ng/L］(P<0.05). At 3 and 7 d after operation, MMSE scores in both groups were lower than those at 1 d before operation; MMSE scores in the SGB group were higher than those in the control group(P<0.05). Conclusion    SGB can effectively reduce neuroendocrine, maintain intraoperative hemodynamic stability and relieve postoperative neurological dysfunction.