超声引导下星状神经节阻滞对胃肠手术患者围术期炎症反应及术后胃肠功能恢复的影响  

Effect of ultrasound-guided stellate ganglion block on perioperative inflammatory responses and postoperative recovery of gastrointestinal function in patients undergoing gastrointestinal surgery

作　　者：褚丽花 王亚 吴水晶[1] 叶慧 李会[1] 陆雅萍 王海宏[3] 方向明[1] 谢郭豪[1] Chu Lihua;Wang Ya;Wu Shuijing;Ye Hui;Li Hui;Lu Yaping;Wang Haihong;Fang Xiangming;Xie Guohao(Department of Anesthesiology,First Affiliated Hospital,College of Medicine,Zhejiang University,Hang-zhou 310003,China;Department of Anesthesiology,Jiaxing First Hospital,Jiaxing 314000,China;Department of Anesthesiology,Sir Run Run Shaw Hospital,College of Medicine,Zhejiang University,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属第一医院麻醉科,杭州市310003 [2]嘉兴市第一医院麻醉科,314000 [3]浙江大学医学院附属邵逸夫医院麻醉科,杭州市310000

出　　处：《中华麻醉学杂志》2018年第8期904-907,共4页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金青年科学基金(81401565);浙江省医药卫生科技计划项目(2015KYA088).

摘　　要：目的 探讨超声引导下星状神经节阻滞(SGB)对胃肠手术患者围术期炎症反应及术后胃肠功能恢复的影响.方法 择期胃肠道手术患者55例,年龄18~64岁,性别不限,ASA分级Ⅰ-Ⅲ级,体重50~75 kg,采用随机数字表法分为2组:SGB组(n=18)和对照组(C组,n=37).SGB组于左侧第6颈椎水平在超声引导下行SGB操作,注入0.5%罗哌卡因7 ml。C组于同一部位超声引导下注入等容量生理盐水.分别于SGB前5 min、SGB后2、4和24 h时采集外周静脉血样,采用ELISA法测定血浆TNF-α、IL-1β和IL-6的浓度.记录白细胞增高水平(SGB后24 h时白细胞计数-SGB前24 h时白细胞计数).记录术后第1次肠鸣音恢复时间和肛门∕造口排气时间.结果 与C组比较,SGB组SGB后2 h时血浆TNF-α浓度及SGB后2、4、24 h时血浆IL-1β浓度降低,白细胞增高水平降低,肠鸣音恢复时间和肛门∕造口排气时间缩短(P<0.05).结论 超声引导下SGB可减轻胃肠手术患者围术期炎症反应,促进术后胃肠功能恢复.Objective To investigate the effect of ultrasound-guided stellate ganglion block ( SGB) on perioperative inflammatory responses and postoperative recovery of gastrointestinal function in patients un-dergoing gastrointestinal surgery. Methods Fifty-five American Society of Anesthesiologists physical classⅠ-Ⅲpatients of both sexes, aged 18-64 yr, weighing 50-75 kg, undergoing elective gastrointestinal sur-gery, were divided into SGB group ( n=18) and control group ( C group, n=37) using a random number table method. Ultrasound-guided SGB was conducted with 0. 5% ropivocaine 7 ml at the left C6 level in SGB group. The equal volume of normal saline was given under ultrasound guidance at the same site in C group. Peripheral venous blood samples were collected at 5 min before SGB and 2, 4 and 24 h after SGB for deter-mination of plasma tumor necrosis factor-α ( TNF-α) , interleukin ( IL)-1β and IL-6 concentrations by en-zyme-linked immunosorbent assay. The increased level of leukocyte count ( leukocyte count at 24 h after SGB-leukocyte count at 24 h before SGB) was recorded. The recovery time of bowel sounds and anal or sto-ma exhaust time were also recorded. Results Compared with C group, the concentrations of TNF-α at 2 h after SGB and IL-1βat 2, 4 and 24 h after SGB were significantly decreased, the increased level of leuko-cyte count was decreased, and the recovery time of bowel sounds and anal or stoma exhaust time were short-ened in SGB group ( P<0. 05) . Conclusion Ultrasound-guided SGB can reduce perioperative inflammato-ry responses and promote the recovery of postoperative gastrointestinal function in the patients undergoing gastrointestinal surgery.

关 键 词：超声检查 星状神经节 神经传导阻滞 炎症 胃肠活动 

分 类 号：R656[医药卫生—外科学]