星状神经节阻滞对胸腔镜手术老年患者恶心呕吐及急性应激障碍的影响  

Effect of stele ganglion block on nausea,vomiting and acute stress disorder in elderly patients undergoing thoracoscopic surgery

作　　者：申磊 胡晓露 张青和 SHEN Lei;HU Xiao-lu;ZHANG Qing-he(Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Jiangsu Province,Xuzhou 221000,China;Department of Anesthesiology,Xuzhou Hospital of Traditional Chinese Medicine,Jiangsu Province,Xuzhou 221000,China)

机构地区：[1]徐州医科大学附属医院麻醉科,江苏徐州221000 [2]江苏省徐州市中医院麻醉科,江苏徐州221000

出　　处：《河北医科大学学报》2024年第12期1433-1438,共6页Journal of Hebei Medical University

基　　金：江苏省基础研究计划(自然科学基金)-面上项目(BK20201183)。

摘　　要：目的探讨星状神经节阻滞(stele ganglion block,SGB)对全身麻醉胸腔镜手术老年患者术后恶心呕吐(postoperative nausea and vomiting,PONV)及急性应激障碍的影响。方法选择徐州医科大学附属医院择期行胸腔镜肺病损切除术的老年患者92例,以随机数字表法分为研究组(n=46)与对照组(n=46)。2组均接受全身麻醉,研究组在超声引导下实施SGB,注入0.25%罗哌卡因4 mL。对比2组手术相关指标、术后疼痛程度、术后PONV、急性应激障碍、应激反应、相关蛋白。结果研究组瑞芬太尼用量(1653.08±69.76)μg、丙泊酚用量(417.34±45.06)mg低于对照组(1725.14±75.62)μg、(487.09±51.23)mg(P<0.05),研究组苏醒时间(15.18±2.38)min短于对照组(19.37±3.45)min(P<0.05),2组首次排气时间、首次下床时间比较差异无统计学意义(P>0.05)。2组视觉模拟评分(visual analog scores,VAS)组间、时点间、组间·时点间交互作用比较差异有统计学意义(P<0.05),2组PONV分级比较差异有统计学意义(P<0.05),研究组术后24 h PONV发生率(21.74%)低于对照组(54.35%)(P<0.05)。2组急性应激反应量表(acute stress disorder scale,ASDS)评分组间、时点间、组间·时点间交互作用比较差异有统计学意义(P<0.05)。术后24 h,2组血清皮质醇(cortisol,CORT)、去甲肾上腺素(norepinephrine,NE)、磷酸化tau-181(phosphorylated tau-181,p-tau-181)、β淀粉样蛋白1-42(β-amyloid 1-42,Aβ1-42)水平均升高(P<0.05),而研究组低于对照组(P<0.05)。结论SGB可降低胸腔镜手术老年患者术中麻醉药物用量,降低PONV发生风险,缓解急性应激反应相关症状。Objective To investigate the effects of stele ganglion block(SGB)on postoperative nausea and vomiting(PONV)and acute stress disorder in elderly patients after thoracoscopic surgery under general anesthesia.Methods A total of 92 elderly patients undergoing elective thoracoscopic lung lesion resection in the Affiliated Hospital of Xuzhou Medical University were selected and divided into research group(n=46)and control group(n=46)by random number table method.Both groups received general anesthesia and the research group was given SGB under ultrasound guidance with 0.25%ropivacaine 4 mL.Postoperative indexes,postoperative pain,PONV,acute stress disorder,stress response and related proteins were compared between the two groups.Results The dosage of remifentanil(1653.08±69.76)μg and propofol(417.34±45.06)mg in the study group were lower than those in the control group(1725.14±75.62)μg and(487.09±51.23)mg(P<0.05).The recovery time of the study group(15.18±2.38)min was shorter than that of the control group(19.37±3.45)min(P<0.05).There was no statistically significant difference in the first exhaust time and first getting out of bed time between the two groups(P>0.05).Interactions between two groups of visual analog scores(VAS):between groups,between time points,and between groups and time points.The difference was statistically significant(P<0.05),and there was a significant difference in PONV grading between the two groups(P<0.05).The incidence of PONV 24 hours after surgery in the study group(21.74%)was lower than that in the control group(54.35%)(P<0.05).There was a statistically significant difference(P<0.05)in the interaction between two groups of acute stress disorder scale(ASDS)scores,including between groups,time points,and between groups and time points.24 hours after surgery,the levels of serum cortisol(CORT),norepinephrine(NE),phosphorylated tau-181(p-tau-181),andβ-amyloid 1-42(β-amyloid 1-42,Aβ1-42)in both groups increased(P<0.05),while the study group was lower than the control group(P<0.05).Con

关 键 词：胸腔镜检查 星状神经节 应激障碍 创伤性 急性 

分 类 号：R561[医药卫生—呼吸系统]