SGB对aSAH患者介入术后认知功能和血管痉挛的影响  

Impacts of SGB on cognitive function and vasospasm after intervention operation in patients with aSAH

作　　者：王士强[1] 张颖 陈奇宏[1] 曹阳[2] Wang Shiqiang;Zhang Ying;Chen Qihong;Cao Yang(Department of Anesthesiology,Zhuozhou City Hospital,Zhuozhou,Hebei,072750,China;Department of Neurology,Zhuozhou City Hospital,Zhuozhou,Hebei,072750,China)

机构地区：[1]涿州市医院麻醉科,河北涿州072750 [2]涿州市医院神经内科,河北涿州072750

出　　处：《西南国防医药》2018年第9期812-814,共3页Medical Journal of National Defending Forces in Southwest China

基　　金：保定市科学技术和知识产权局课题(17ZF119)

摘　　要：目的探究星状神经节阻滞(SGB)对动脉瘤性蛛网膜下腔出血(aSAH)患者介入术后认知功能及血管痉挛的影响。方法随机将择期行介入术的60例aSAH患者均分为两组,观察组麻醉诱导后对患侧行连续SGB,注入0.25%罗哌卡因6～8 ml后,2%罗哌卡因持续泵注3 d,2 ml/h,对照组不予以SGB干预。测定手术前后血浆内皮素-1(ET-1)、降钙素基因相关肽(CGRP)水平,并行简易智力状态检查量表(MMSE)评分,统计两组术后72 h内血管痉挛、认知功能障碍发生率。结果术后24、72 h,两组ET-1水平较术前显著上升,CGRP水平和MMSE评分显著下降(P <0.05),且观察组的变化幅度均低于对照组(P <0.05);术后72 h内,观察组血管痉挛、认知功能障碍发生率分别为6.67%、16.67%,均显著低于对照组的36.67%、50.00%(P <0.05)。结论 SGB能有效降低aSAH患者介入术后血管痉挛和认知功能障碍发生率,其机制可能与SGB抑制ET-1释放,促CFRP释放相关。Objective To explore the impacts of stellate ganglion block （SGB） on the cognitive function and vasospasm after intervention operation in the patients with aneurysmal subarachnoid hemorrhage （aSAH）. Methods A total of 60 patients with aSAH to receive intervention operation were randomly divided into an observation group and a control group （n=30, respectively）. The observation group received continuous SGB on the affected side after anesthesia induction and was injected with 6-8 ml 0.25% ropivacaine and pumped with 2% ropivacaine for three consecutive days, 2 ml/h. The control group received no SGB intervention. The levels of endothelin-1 （ET-1） and calcitonin generelated peptide （CGRP） before and after the operation were determined. Mini-mental state examination （MMSE） was conducted to obtain the incidence of vasospasm and cognition impairment within 72 hours after the operation, Results 24 and 72 hours after the operation, the levels of ET-1 in the two groups were significantly higher than those before the operation, while the CGRP levels and MMSE scores decreased significantly （P 〈 0.05）, and the changes in the observation group were less than those in the control group （P 〈 0.05）; 72 hours after the operation, the incidence of vasospasm and cognition impairment in the observation group was 6.67% and 16.67% respectively, significantly lower than the 36.67% and 50.00% in the control group （P 〈 0.05）. Conolusion SGB can effectively lower the incidence of vasospasm and cognition impairment after intervention operation in patients with aSAH. Its mechanism may be correlated to its inhibition of the release of ET-1 and the promotion of that of CFRP.

关 键 词：动脉瘤 蛛网膜下腔出血 星状神经节阻滞 介入术 认知功能 血管痉挛 

分 类 号：R739.41[医药卫生—肿瘤]