星状神经节阻滞对颅内动脉瘤夹闭术患者炎性因子和术后恢复质量的影响  

Effect of ultrasound-guided stellate ganglion block on inflammatory factors and postoperative recovery quality in patients undergoing intracranial aneurysm clipping surgery

作　　者：倪亚平 杨芬[1] 韩丽 赵月 袁晨 杨昌建 谢阳 NI Yaping;YANG Fen;HAN Li;ZHAO Yue;YUAN Chen;YANG Changjian;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,江苏苏州215002

出　　处：《大连医科大学学报》2024年第5期392-399,共8页Journal of Dalian Medical University

基　　金：江苏省自然科学基金项目(BK20180214)。

摘　　要：目的探讨超声引导下星状神经节阻滞(SGB)对颅内动脉瘤夹闭术后患者早期恢复及炎症指标的影响,以期为SGB在围术期脑保护领域的应用提供理论依据。方法本研究纳入2021年10月至2023年12月期间收治的83例颅内动脉瘤并发蛛网膜下腔出血(SAH)患者,所有患者均接受了颅内动脉瘤夹闭术。使用随机数字表法将患者分为SGB组(42例)和对照组(41例)。SGB组患者在麻醉诱导前接受患侧的SGB治疗,采用0.25%罗哌卡因+1%利多卡因的混合液5 mL进行阻滞;对照组不做处理。阻滞后10~15 min内观察到霍纳综合征为阻滞成功。分别记录两组患者各时点的平均动脉压(MAP)和心率(HR)。利用酶联免疫吸附试验(ELISA)技术,对患者颈内静脉血样中的关键炎症标志物白介素-1β(IL-1β)、白介素-6(IL-6)、白介素-10(IL-10)以及肿瘤坏死因子-α(TNF-α)进行定量分析,评估炎症反应的程度。对两组患者在术前1天、术后1、3和7天进行恢复质量(QoR-15)评分和简易智力状态检查量表(MMSE)评分的跟踪评估。监测并比较术后7天内两组患者并发症发生情况。结果与对照组相比,SGB组患者术中HR和MAP明显降低(P<0.05);术后IL-1β、IL-6和TNF-α水平也明显降低,而IL-10水平则相对较高(P<0.05)。术后第1天、第3天,SGB组患者的QoR-15总评分明显高于对照组(P<0.05);术后第1、3、7天的MMSE评分明显高于对照组(P<0.05)。此外,术后7天内SGB组脑血管痉挛、脑积水、脑梗死和颅内感染的发生率明显低于对照组(19.05%vs 46.34%,P<0.05)。结论颅内动脉瘤夹闭术前SGB能够有效减轻炎症反应,促进患者术后恢复,改善术后认知功能。Objective To investigate the effect of ultrasound-guided stellate ganglion block(SGB)on early recovery and inflammatory markers in patients after intracranial aneurysm clipping surgery,in order to provide a theoretical basis for the application of SGB in perioperative neuroprotection.Methods A total of 83 patients with intracranial aneurysms complicated by subarachnoid hemorrhage,who were admitted between October 2021 and December 2023,were included in the study.All patients underwent intracranial aneurysm clipping surgery.Using random number table method,patients were divided into the SGB group(42 cases)and the control group(41 cases).Patients in the SGB group received ipsilateral SGB treatment before anesthesia induction with a 5 mL mixture of 0.25%ropivacaine and 1%lidocaine,while the control group received no treatment.Successful blockade was defined as the appearance of Horner's syndrome within 10-15 minutes after the block.Mean arterial pressure(MAP)and heart rate(HR)were recorded at different time points.Key inflammatory markers,including interleukin-1β(IL-1β),interleukin-6(IL-6),interleukin-10(IL-10),and tumor necrosis factor-alpha(TNF-α),were quantitatively analyzed in internal jugular venous blood samples using enzyme-linked immunosorbent assay(ELISA)to evaluate the degree of inflammation.The Quality of Recovery-15(QoR-15)and Mini-Mental State Examination(MMSE)scores were assessed preoperatively(1 day before surgery)and postoperatively(on days 1,3,and 7).Postoperative complications within 7 days were monitored and compared between the two groups.Results Compared with the control group,intraoperative HR and MAP were significantly lower in the SGB group(P<0.05).Postoperative levels of IL-1β,IL-6,and TNF-αwere significantly reduced,while IL-10 levels were relatively higher in the SGB group(P<0.05).The QoR-15 scores on postoperative days 1 and 3 were significantly higher in the SGB group than in the control group(P<0.05).The MMSE scores on postoperative days 1,3,and 7 were also significantly higher in

关 键 词：星状神经节阻滞 颅内动脉瘤夹闭术 炎性因子 恢复质量 认知功能 

分 类 号：R473.6[医药卫生—护理学]