超声引导下星状神经节阻滞联合右美托咪定对老年心脏手术患者炎性反应及术后认知功能影响的前瞻性随机对照研究  

Impact of ultrasound-guided stellate ganglion block combined with dexmedetomidine on inflammatory response and postoperative cognitive function in elderly patients undergoing cardiac surgery:a prospective randomized controlled study

作　　者：王涛涛 翟明 刘梦雅 代文涛 凌云志 李晓红 王南海 Wang Taotao;Zhai Ming;Liu Mengya;Dai Wentao;Ling Yunzhi;Li Xiaohong;Wang Nanhai(Department of Anesthesiology,the First Affiliated Hospital of Bengbu Medical University,Bengbu 233004,China)

机构地区：[1]蚌埠医科大学第一附属医院麻醉科,蚌埠233004

出　　处：《中华解剖与临床杂志》2024年第11期752-758,共7页Chinese Journal of Anatomy and Clinics

基　　金：蚌埠医学院自然科学基金重点项目(2021byzd132)。

摘　　要：目的:探讨超声引导下星状神经节阻滞(SGB)联合右美托咪定对老年心脏手术患者的炎性反应和术后认知功能的影响。方法:前瞻性随机对照研究。纳入2022年1月—2023年12月蚌埠医科大学第一附属医院拟行择期心脏手术的患者59例,其中男39例、女20例,拟行心脏瓣膜置换术35例、冠脉搭桥术24例,年龄65~77(69.2±3.0)岁。采用数字表法将59例患者随机分为SGB联合右美托咪定组(SD组)30例和右美托咪定组29例。SD组患者麻醉诱导前行右侧SGB,同时给予右美托咪定持续泵注,直到手术结束;右美托咪定组患者麻醉诱导前10 min开始给予右美托咪定持续泵注,直到手术结束。观察指标:(1)比较2组患者性别、年龄、体质量、美国麻醉医师协会(ASA)分级、手术方式等临床基线资料。(2)比较2组患者术中体外循环时间、手术时间、术中出血量等情况,以及术中心动过缓、高血压、低血压等并发症发生率;比较2组患者术后第1、3、7天疼痛视觉模拟评分法(VAS)评分,以及机械通气时间、监护室滞留时间。(3)比较2组患者麻醉后手术前(T0)、术后6 h(T1)、术后24 h(T2)的血清炎性反应指标肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6水平。(4)采用蒙托利尔认知评估量表(MoCA)评价并比较2组患者术前1天和术后第1、3、7天认知功能评分,以及术后第1天认知功能障碍发生率。结果:(1)2组患者性别、年龄、体质量、ASA分级、手术方式等临床基线资料比较,差异均无统计学意义(P值均>0.05)。(2)2组患者术中体外循环时间、手术时间、术中出血量及高血压发生率比较,差异均无统计学意义(P值均>0.05);SD组患者术中心动过缓和低血压发生率较右美托咪定组减少,差异均有统计学意义(χ^(2)=4.00、3.93,P值均<0.05)。2组患者术后第1、3、7天疼痛VAS评分比较,差异均无统计学意义(P值均>0.05);SD组患者术后机械通气时间和监护室滞留�Objective This study aimed to investigate the effects of stellate ganglion block(SGB)under ultrasound guidance combined with dexmedetomidine on the inflammatory response and postoperative cognitive function of elderly patients undergoing cardiac surgery.Methods A prospective randomized control study was conducted from January 2022 to December 2023.Fifty-nine patients,including 39 males and 20 females,aged 65-77(69.2±3.0)years,who underwent elective cardiac surgery in the First Affiliated Hospital of Bengbu Medical University were included.Among them,35 underwent heart valve replacement and 24 underwent coronary artery bypass grafting.The patients were randomly divided into two groups by using the numerical table method.The SD group(stellate ganglion block combined with dexmedetomidine group)had 30 cases,and the dexmedetomidine group was composed of 29 cases.The SD group received right stellate ganglion block before anesthesia induction,followed by continuous infusion of dexmedetomidine until the end of surgery.The dexmedetomidine group received continuous infusion of dexmedetomidine from 10 min before anestheia incluction until the end of surgery.The observation indices were as follows.(1)The baseline clinical data,such as gender,age,weight,American Society of Anesthesiologists(ASA)classification,and type of surgery,were compared between the two groups.(2)The intraoperative cardiopulmonary bypass time;operation time;intraoperative blood loss;and incidence of complications,such as bradycardia,hypertension,and hypotension,were compared between the two groups.The postoperative pain visual analogue scale(VAS)score at the first,third,and seventh day after surgery;the mechanical ventilation time;and the ICU stay time were compared between the two groups.(3)The inflammatory response indices,including blood tumor necrosis factor(TNF)-αand interleukin(IL)-6,were recorded and compared between the two groups after anesthesia and before surgery(T0),6 h after surgery(T1),and 24 h after surgery(T2).(4)The Montolier Cognitive

关 键 词：神经传导阻滞 星状神经节阻滞 右美托咪定 心脏手术 老年患者 炎性反应 认知功能 

分 类 号：R614[医药卫生—麻醉学]