星状神经节阻滞对胃癌手术患者术后胃肠功能恢复及炎症应激反应的影响  

Impact of stellate ganglion block on postoperative gastrointestinal function and inflammatory stress response in patients undergoing gastric cancer surgery

作　　者：张爽 司小萌 梁玉柱 王旭 ZHANG Shuang;SI Xiao-meng;LIANG Yu-zhu;WANG Xu(Department of Anesthesiology,Nanyang Cancer Hospital,Nanyang 473000,Henan,CHINA)

机构地区：[1]南阳市肿瘤医院麻醉科,河南南阳473000

出　　处：《海南医学》2024年第15期2185-2190,共6页Hainan Medical Journal

基　　金：河南省医学科技项目计划项目(编号:2018020469)。

摘　　要：目的探究星状神经节阻滞对胃癌手术患者术后胃肠功能恢复及炎症应激反应的影响。方法前瞻性纳入2020年1月至2022年1月在南阳市肿瘤医院拟接受腹腔镜下胃癌根治术治疗的103例胃癌患者作为研究对象,采用信封法分为对照组(n=51)和研究组(n=52)。对照组患者行全麻复合硬膜外麻醉(CEGA),研究组患者行星状神经节阻滞联合CEGA麻醉。比较两组患者麻醉前后不同时间点的血流动力学变化、视觉模拟评分(VAS)以及手术前后不同时间的炎症因子和应激反应水平,同时比较两组患者的胃肠功能恢复情况和术后并发症发生情况。结果入室时两组患者的收缩压、舒张压及心率比较差异均无统计学意义(P>0.05);与入室时比较,两组患者插管后、切皮后、手术开始1 h时的收缩压、舒张压及心率均降低,且研究组的收缩压、舒张压和心率明显低于对照组,差异均有统计学意义(P<0.05)。术后2 h、24 h、48 h时,两组患者的VAS评分比较差异均无统计学意义(P>0.05)。两组患者术前的超敏C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素8(IL-8)、白细胞介素6(IL-6)水平比较差异均无统计学意义(P>0.05);与术前比较,两组患者术后的上述各指标水平均降低,且研究组术后的CRP、TNF-α、IL-8、IL-6水平明显低于对照组,差异均有统计学意义(P<0.05)。切皮1 h时,两组患者的超氧化物歧化酶(SOD)、皮质醇(Cortisol)、血清丙二醇(PG)水平比较差异均无统计学意义(P>0.05);与切皮1 h时相比较,术毕两组患者的SOD、Cortisol、PG水平均升高,且研究组术毕的上述各指标明显低于对照组,差异均有统计学意义(P<0.05)。术后研究组患者的进食时间、排气时间及肠鸣音恢复时间分别为(33.12±5.79)h、(30.56±4.49)h、(23.64±6.11)h,明显短于对照组的(53.16±6.78)h、(52.11±6.12)h、(31.08±5.97)h,差异均有统计学意义(P<0.05)。术后两组患者的恶心、�Objective To explore the effects of stellate ganglion block(SGB)on the recovery of gastrointesti-nal function and the inflammatory stress response in patients undergoing gastric cancer surgery.Methods From Janu-ary 2020 to January 2022,103 gastric cancer patients scheduled for laparoscopic radical gastrectomy at Nanyang Cancer Hospital were prospectively enrolled.They were divided into two groups using sealed envelope randomization:a control group(n=51)receiving combined epidural and general anesthesia(CEGA)and a study group(n=52)undergoing SGB in addition to CEGA.Hemodynamic changes,Visual Analogue Scale(VAS)scores,inflammatory markers,and stress re-sponse levels at various time points before and after anesthesia were compared between the two groups,as well as the re-covery of gastrointestinal function and postoperative complications.Results Initial systolic and diastolic blood pres-sure and heart rates showed no significant differences between the two groups(P>0.05).At post-intubation,post-inci-sion,and 1 hour into surgery,the above parameters decreased in both groups,and the levels in the study group were sig-nificantly lower than those in the control group(P<0.05).VAS scores at 2 h,24 h,and 48 h after surgery did not differ significantly between the two groups(P>0.05).Before surgery,levels of hypersensitive C-reactive protein(CRP),tumor necrosis factor-alpha(TNF-α),interleukin-8(IL-8),and interleukin-6(IL-6)showed no statistically significant differ-ence between the two groups(P>0.05);after surgery,the levels all decreased,and the levels in the study group were sig-nificantly lower than those in the control group,with statistically significant differences(P<0.05).There were no signifi-cant differences in the levels of superoxide dismutase(SOD),cortisol,and serum propylene glycol(PG)at 1 h after inci-sion(P>0.05);after surgery,the levels increased significantly,and the levels in the study group were significantly lower than those in the control group,with statistically significant differences(P<0.05).The reco

关 键 词：胃癌 星状神经节阻滞 全麻复合硬膜外麻醉 胃肠功能 炎症反应 

分 类 号：R735.2[医药卫生—肿瘤]