超声引导下星状神经节阻滞对老年腹腔镜胆囊切除术脑部血液灌注和认知功能的影响  

Impact of ultrasound-guided stellate ganglion block on blood perfusion and cognitive function in elderly patients undergoing laparoscopic cholecystectomy

作　　者：贾莲明 胡引芳 余文富 JIA Lianming;HU Yinfang;YU Wenfu(Department of Anesthesiology,Shanghai Electric Power Hospital,Shanghai 200050,China)

机构地区：[1]上海电力医院麻醉科,上海200050

出　　处：《安徽医药》2020年第10期2058-2063,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的观察超声引导下星状神经节阻滞对胆囊切除术老年病人脑部血液灌注和认知功能的影响。方法选择2017年1月至2018年12月在上海电力医院就诊行胆囊切除术的老年病人130例,按照随机数字表法,将病人分为观察组和对照组,每组各65例。对照组使用普通全麻,观察组在对照组的基础上行星状神经节阻滞(SGB)。在进入手术室时(T0)、气管插管时(T1)、建立气腹时(T2)、胆囊切除即刻(T3)和气管拔除时(T4)各个时点,比较两组平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、颈内静脉球部血氧饱和度(SjvO2)、桡动脉-颈内静脉球部血氧含量差值(Da-jvO2)、脑氧摄取率(CEO2)、葡萄糖摄取率(GluER)、脑乳酸生成率(LacPR)和β-淀粉样多肽-42(Aβ-42)水平的变化;比较两组自主呼吸恢复时间、拔管时间、苏醒时间和抬头时间及两组在术前、术后1 d、3 d、5 d和7 d的简易智力状态量表(MMSE)和视觉模拟疼痛评分(VAS)水平。结果观察组的自主呼吸恢复时间(2.76±1.38)min、拔管时间(8.09±2.37)min、苏醒时间(11.61±3.62)min和抬头时间(16.34±2.49)min明显短于对照组(3.48±1.63)、(9.68±2.55)、(13.53±4.18)、(18.68±3.18)min(均P<0.01)。两组术前MMSE和VAS水平差异无统计学意义(P>0.05),术后1 d两组的MMSE水平均较术前显著降低(P<0.01),术后3~7 d两组MMSE水平均较术后1d出现显著上升(P<0.01),而观察组的MMSE上升幅度较对照组更为显著(P<0.01);术后1 d两组VAS水平较术前显著升高(P<0.01),术后3~7 d两组的VAS水平较术后1d出现显著下降(P<0.01),而观察组的VAS降低幅度较对照组更为显著(P<0.01)。两组在T0时点的MAP、HR、SjvO2、Da-jvO2、CEO2、GluER、LacPR和Aβ-42差异无统计学意义(P>0.05),麻醉后对照组T1~T4时点的MAP、GluER和LacPR水平明显低于同组T0时点及观察组(P<0.01),而HR在T1~T4时点明显高于T0和观察组(P<0.01);观察组SjvO2在T1~T4时点的较T0和对照明显升高Objective To observe the impact of ultrasound-guided stellate ganglion block on blood perfusion and cognitive functionin elderly patients with cholecystectomy.MethodsA total of 130 elderly patients who underwent cholecystectomy in ShanghaiElectric Power Hospital from January 2017 to December 2018 were divided into observation group and control group according tothe random number table,with 65 cases in each group.The control group performed with general anesthesia and the observationgroup was given the stellate ganglion block(SGB)on the basis of the control group.The mean arterial pressure(MAP),heart rate(HR),pulse oxygen saturation(Sp O2),jugular venous oxygen saturation(Sjv O2),difference in arterial-jugular bulb oxygen content(Da-jv O2),cerebral extraction of oxygen(CEO2),glucose uptake rate(Glu ER),cerebral lactate production rate(Lac PR)and amy-loidβ-42(Aβ-42)levels in the two groups were compared at each time point of entering the operating room(T0),tracheal intuba-tion(T1),establishing pneumoperitoneum(T2),immediate cholecystectomy(T3)and tracheal extraction(T4);the spontaneousbreathing recovery time,extubation time,awakening time and head-up time in the two groups were also compared and the mini-men-tal state examination(MMSE)andvisual analogue score(VAS)levels were compared in the two groups by day 1,day 3,day 5 andday7 after surgery.ResultsThe spontaneous breathing recovery time(2.76±1.38 vs.3.48±1.63)min,extubation time(8.09±2.37 vs.9.68±2.55)min,awakening time(11.61±3.62 vs.13.53±4.18)min and head-up time(16.34±2.49 vs.18.68±3.18)minin the obser-vation group were significantly shorter than those in the control group(P<0.01).There was no significant difference in the levelsof MMSE and VAS between the two groups before surgery(P>0.05),the MMSE levels in the two groups by day1 after surgerywere significantly lower than those before surgery(P<0.01),the MMSE levels in the two groups by day 3-7 after surgery were sig-nificantly higher than those by day 1 after surgery(P<0.01),while the increasing l

关 键 词：自主神经传导阻滞 星状神经节 胆囊切除术 腹腔镜 老年人 认知功能 脑氧代谢 

分 类 号：R614[医药卫生—麻醉学]