星状神经节阻滞在慢性鼻窦炎合并高血压患者围手术期中的应用  

Efficacy of stellate ganglion block in perioperative period of patients with chronic sinusitis and hypertension

作　　者：胡晓清[1] 郑小艳[2] 马文霞[3] 江漩[2] Hu Xiaoqing;Zheng Xiaoyan;Ma Wenxia;Jiang Xuan(Department of Otorhinolaryngology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Anesthesiology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Quality Management,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院耳鼻咽喉科,苏州215006 [2]苏州大学附属第一医院麻醉科,苏州215006 [3]苏州大学附属第一医院质量管理处,苏州215006

出　　处：《中华医学杂志》2020年第33期2591-2595,共5页National Medical Journal of China

摘　　要：目的观察星状神经节阻滞(SGB)对合并高血压的慢性鼻窦炎患者功能性内镜鼻窦手术(FESS)围手术期的影响。方法选取2018年4月至2019年12月苏州大学附属第一医院耳鼻咽喉科拟行FESS的慢性鼻窦炎合并高血压患者60例,采用随机数字表法分为SGB组(n=30)和对照组(n=30)。SGB组分别于术前24 h及全麻诱导前双侧交替行SGB,对照组未给予特殊处理。术中常规控制性降压。分别于术前24 h(T0)、麻醉诱导前(T1)、手术开始时(T2)、手术结束时(T3)、术后24 h(T4)记录患者收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)和心率(HR)等血流动力学指标。选取T0、T1、T3、T4时间点检测两组患者血浆肾上腺素、去甲肾上腺素浓度。记录两组患者术中麻醉等药物用量、手术持续时间、术中出血总量、术后拔管时间,并评价术野质量。分别于术后1、6、24 h评估疼痛视觉模拟评分(VAS)。结果SGB组在T1、T2、T3、T4各时间点的SBP、DBP、MAP和T1、T4时间点的HR均低于对照组,差异均有统计学意义(均P<0.05)。与T0时间点相比,SGB组内SBP、DBP、MAP、HR在T1、T2、T3、T4时间点均下降,差异均有统计学意义(均P<0.05);对照组SBP、DBP、MAP仅在T2、T3时间点下降,HR波动明显,差异均有统计学意义(均P<0.05)。SGB组患者在T1、T3、T4时间点血浆肾上腺素、去甲肾上腺素浓度均低于对照组,差异均有统计学意义(均P<0.05)。与T0时间点相比,SGB组内血浆肾上腺素、去甲肾上腺素浓度呈正负相波动,而对照组均升高(均P<0.05)。SGB组患者在术后6、24 h疼痛评分分别为(1.3±0.7)、(2.6±0.9)分,低于对照组的(1.7±0.7)、(3.1±0.9)分,差异均有统计学意义(t=-2.290、-2.050,均P<0.05)。结论SGB可有效改善慢性鼻窦炎合并高血压患者围手术期血流动力学,维持机体稳态,减少麻醉以及手术并发症。Objective To observe the perioperative efficacy of stellate ganglion block(SGB)in functional endoscopic sinus surgery(FESS)in chronic sinusitis patients with hypertension.Methods A total of 60 patients with chronic sinusitis complicated with hypertension who were scheduled to undergo FESS in the Department of Otorhinolaryngology,the First Affiliated Hospital of Soochow University from April 2018 to December 2019 were selected and divided into SGB group and control group by random number table method.SGB were performed at 24 hours before surgery and induction of general anesthesia alternately,while the control group was not treated.During the operation,controlled hypotension were performed in both groups.Hemodynamic parameters such as systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial blood pressure(MAP)and heart rate(HR)were recorded at 24 hours before surgery(T0),before anesthesia induction(T1),at the beginning of surgery(T2),at the end of surgery(T3),and at 24 hours after surgery(T4).Plasma epinephrine and norepinephrine concentrations were measured at T0,T1,T3 and T4.The dosage of anesthesia and other drugs,operative time,bleeding amount and extubation time were recorded,while the quality of the operative field was evaluated.VAS scores were assessed at 1,6 and 24 hours after surgery.Results In the SGB group,SBP,DBP and MAP in T1,T2,T3,T4 and HR in T1,T4 were lower than those in the control group(all P<0.05).Compared with T0,SBP,DBP,MAP and HR in T1,T2,T3,T4 all decreased in SGB group(all P<0.05);In the control group,SBP,DBP and MAP only decreased in T2 and T3,and HR fluctuated significantly(P<0.05).In the SGB group,plasma epinephrine and norepinephrine concentrations at T1,T3 and T4 were lower than those in the control group(P<0.05).Compared with T0,plasma epinephrine and norepinephrine concentrations in the SGB group fluctuated in positive and negative phases,while those in the control group increased(P<0.05).The pain scores in SGB group at 6 and 24 hours after surgery were 1.3±0.7 and

关 键 词：星状神经节 神经传导阻滞 鼻窦炎 高血压 功能性内镜鼻窦手术 

分 类 号：R614[医药卫生—麻醉学]