连续星状神经节阻滞对重度颅脑损伤患者血清甲状腺激素及皮质醇水平的影响  

Effects of continuous stellate ganglion block on serum thyroid hormone and cortisol levels in patients with severe brain injury

作　　者：吴坛光[1] 李建华[1] 胡惠英[1] 陈开文[1] 李斌[1] 

机构地区：[1]解放军第一六一医院麻醉科,武汉市430010

出　　处：《中华麻醉学杂志》2011年第3期334-337,共4页Chinese Journal of Anesthesiology

基　　金：武汉后方基地科研基金（200816102）

摘　　要：目的探讨连续星状神经节阻滞对重度颅脑损伤患者血清甲状腺激素[三碘甲状腺原氨酸（T3）、甲状腺素（T4）、反三碘甲状腺原氨酸（rT3）、促甲状腺激素（TSH）]及皮质醇（Cor）水平的影响。方法急诊行开颅手术的重度颅脑损伤患者80例，性别不限，年龄22—61岁，ASA分级Ⅱ或Ⅲ级，格拉斯哥昏迷量表评分3—8分，采用随机数字表法，将患者随机分为2组（n=40）：对照组（c组）和连续星状神经节阻滞组（SGB组）。气管插管后SGB组于开颅侧行连续SGB，注射0．2％罗哌卡因7ml后，持续输注0．2％罗哌卡因2ml／h，持续时间为48h；2组术后均予常规治疗。于术前30min、术后3、7d采集静脉血样，采用放射免疫法测定血清T3、T4、rT3、TSH及Cor浓度；术后90d采用格拉斯哥预后评分判定临床疗效。结果与C组比较，SGB组术后血清L浓度升高，T4、rT3、TSH和Cor浓度降低（P〈0．05或0．01），SGB组临床疗效分级优于c组（P〈0．05）。结论连续星状神经节阻滞可有效减轻重型颅脑损伤患者的应激反应，改善下丘脑-垂体-甲状腺轴功能，有助于患者恢复。Objective To investigate the effects of continuous steUate ganglion block （SGB） on serum thyroid hormone and cortisol levels in patients with severe brain injury. Methods Eighty ASA Ⅱ or Ⅲ patients with severe brain injury aged 22-61 yr undergoing emergency craniotomy were randomly divided into 2 groups （ n = 40 each） ： control group （group C） received routine treatment only and continuous SGB group （group SGB） re- ceived continuous SGB with 0.2 % ropivacaine besides routine treatment. SGB was performed on the operated side after induction of general anesthesia and tracheal intubation. An epidural catheter was placed. A bolus of 0.2 % ropivacaine 7 ml was followed by continuous infusion of 0.2% ropivacaiue at a rate of 2 ml/h. Continuous SGB was maintained for 48 h. Successful SGB was confirmed by increase in skin temperature by ≥1.5℃ behind earlobe on the operated side. Venous blood samples were obtained at 30 min before and 3 and 7 day after operation for determination of serum thyroid stimulating hormone （TSH）, triiodothyronine （T3 ）, thyroxine （T4 ）, reverse triiodothyronine（rT3 ） and eortisol concentrations. Glasgow prognosis score was used to evaluate the clinical results at 3 months after operation. Results Serum T4, rT3, TSH and eortisol concentrations were significantly lower while the serum T3 concentration was higher in the SGB group than in group C at 3 and 7 d after operation. The clinical results were significant better in SGB group than in group C according to Glasgow prognosis scores at 3 months after operation. Conclusion Continuous SGB can inhibit the stress response, and improve hypothalamus-pituitary-thyroid gland axis function and is helpful to patient＇s recovery from injury.

关 键 词：星状神经节 神经传导阻滞 颅脑损伤 甲状腺激素类 氢化可的松 

分 类 号：R614[医药卫生—麻醉学]