超声引导下星状神经节阻滞对颈动脉内膜切除术中脑氧代谢和S100B蛋白的影响  

Effect of ultrasound-guided stellate ganglion block on cerebral oxygen metabolism and S100B protein during carotid endarterectomy

作　　者：杨昌建 韩丽 赵月 袁晨 杨芬[1] 谢阳 Yang Changjian;Han Li;Zhao Yue;Yuan Chen;Yang Fen;Xie Yang(Department of Anesthesiology,the Affiliated Suzhou Hospital of Nanjing Medical University(Suzhou Municipal Hospital),Gusu School of Nanjing Medical University,Suzhou 215002,China)

机构地区：[1]南京医科大学附属苏州医院(苏州市立医院)麻醉科,南京医科大学姑苏学院,苏州215002

出　　处：《国际脑血管病杂志》2023年第9期664-671,共8页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨超声引导下星状神经节阻滞(stellate ganglion block,SGB)对颈动脉内膜切除术(carotid endarterectomy,CEA)过程中脑氧代谢和血清S100B的影响。方法前瞻性纳入2021年6月至2023年4月在南京医科大学附属苏州医院择期全身麻醉下行CEA的患者,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级为Ⅱ~Ⅲ级,年龄40~75岁,随机分为SGB组和对照组。在麻醉诱导前,SGB组在超声引导下行同侧SGB,对照组不行SGB。在全身麻醉下行超声引导下右侧锁骨下静脉置管术,记录全麻诱导前(T0)、气管插管时(T1)、血管阻断前(T2)、血管开放后(T3)和手术结束时(T4)的平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR)以及T1~T4各时间点颈内静脉球部压力。在各时间点采集动脉血和颈内静脉球部血进行血气分析,计算颈静脉球部血氧饱和度(jugular venous bulb oxygen saturation,SjvO_(2))、动静脉血氧含量差(arteriovenous oxygen content difference,AVDO_(2))、脑氧摄取率(cerebral oxygen extraction rate,COER)、乳酸生成率(lactate production rate,LPR)和乳酸氧指数(lactate-oxygen index,LOI)。通过酶联免疫吸附法检测各时间点颈内静脉球部血血清S100B浓度。记录术后声音嘶哑、血肿、头晕、膈神经阻滞、恶心和呕吐发生率。结果共纳入82例行CEA的患者,SGB组和对照组各41例。SGB组麻醉诱导和手术过程中HR显著低于对照组,气管插管和手术开始时MAP和HR也较对照组更稳定(P均<0.05)。SGB组SjvO_(2)、AVDO_(2)和COER在T1~T3期间变化较小,而在T4时SjvO_(2)升高,AVDO_(2)和CEOR降低。相比之下,对照组SjvO_(2)、AVDO_(2)和COER在T3时下降,T4时略有回升。SGB组各时间点SjvO_(2)均显著高于对照组(P均<0.05)。两组AVDO_(2)和COER均随时间推移逐渐降低,对照组各时间点均显著高于SGB组(P均<0.05)。两组LPR和LOI在T1~T4期间增高,T3时达最高值,T4时有所下降,对照组T4时与T2时比较差异有�Objective To investigate the effect of ultrasound-guided stellate ganglion block(SGB)on cerebral oxygen metabolism and serum S100B protein during carotid endarterectomy(CEA).Methods Patients aged 40-75 years old,classified as GradeⅡ-Ⅲby the American Society of Anesthesiologists(ASA),and underwent elective CEA under general anesthesia at the Affiliated Suzhou Hospital of Nanjing Medical University from June 2021 to April 2023 were prospectively enrolled.They were randomly divided into an SGB group and a control group.Before anesthesia induction,the SGB group underwent ipsilateral SGB under the ultrasound guidance,while the control group did not undergo SGB.The right subclavian vein catheterization was performed under the ultrasound guidance during the general anesthesia.The mean arterial pressure(MAP)and heart rate(HR)were recorded before induction of general anesthesia(T0),during tracheal intubation(T1),before vascular occlusion(T2),after vascular opening(T3),and at the end of surgery(T4),as well as the pressure of the jugular vein bulb at each time point from T1 to T4.Arterial blood and jugular venous bulb blood were collected at various time points for blood gas analysis.Jugular venous bulb oxygen saturation(SjvO_(2)),arteriovenous oxygen content difference(AVDO_(2)),cerebral oxygen extraction rate(COER),lactate production rate(LPR)and lactate oxygen index(LOI)were calculated.The serum S100B concentration in the jugular vein bulb blood at various time points was detected with enzyme-linked immunosorbent assay.The incidence of postoperative hoarseness,hematoma,dizziness,diaphragmatic nerve block,nausea,and vomiting were recorded.Results A total of 82 patients conducted CEA were included,with 41 patients in the SGB group and 41 in the control group.During anesthesia induction and surgery in the SGB group,HR was significantly lower than that in the control group,and the MAP and HR during tracheal intubation and at the beginning of surgery were also more stable than those in the control group(all P<0.05).In the

关 键 词：颈动脉内膜切除术 星状神经节 自主神经传导阻滞 超声检查 介入性 氧 乳酸 S100钙结合蛋白β亚单位 

分 类 号：R614[医药卫生—麻醉学]