超声引导下星状神经节阻滞对老年单肺通气患者肺内分流及脑氧代谢的影响  

Effects of utrasound-guided stellate ganglion block on pulmonary shunting and cerebral oxygen metabolism in elderly patients undergoing single-lung ventilation

作　　者：周云 韩丽 赵月 袁晨 杨昌建 杨芬[1] 谢阳 Zhou Yun;HanLi;Zhao Yue;Yuan Chen;Yang Changjian;Yang Fen;Xie Yang(Department of Anesthesiology,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215000,China;Department of Anesthesiology,Xinghai Hospital of Suzhou Industrial Park,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,215000 [2]苏州工业园区星海医院麻醉科,215002

出　　处：《中华老年病研究电子杂志》2024年第2期20-25,共6页Chinese Journal of Geriatrics Research(Electronic Edition)

基　　金：江苏省自然科学基金项目(BK20180214);上海闵行区卫生健康委员会科研项目(2023MW69)

摘　　要：目的观察超声引导下星状神经节阻滞(SGB)对老年单肺通气患者肺内分流和脑氧代谢的影响。方法选择2020年4月至2022年10月于南京医科大学附属苏州医院择期行单肺通气下胸腔手术的老年患者96例,其中48例在全身麻醉前行超声引导下通气侧SGB(SGB组),余48例不给予SGB(对照组)。在手术开始即刻(T0),双肺通气15 min后(T1),单肺通气15 min后(T2)、30 min后(T3)、60 min后(T4),以及恢复双肺通气15 min后(T5),监测并记录患者的生理指标,包括平均动脉压(MAP)和心率,并进行桡动脉血和颈内静脉球部血的血气分析,计算肺内分流量和氧合指数;同时,记录颈静脉血氧饱和度(SvO_(2))和阻滞侧脑氧饱和度(rSO_(2)),通过公式计算脑氧耗量(Ca-vO_(2))、脑氧摄取率(CERO_(2))。记录与SGB相关的并发症,以及术后72 h内肺部并发症的发生情况。计量资料的比较采用t检验或重复测量方差分析,计数资料的比较采用χ^(2)检验。结果最终纳入统计分析患者共93例,其中SGB组46例,对照组47例。SGB组患者在手术过程中的心率较对照组低,MAP也较对照组更稳定(F=333.662,P<0.05)。单肺通气后,两组患者肺内分流量明显增加。在T2~T5时间点,SGB组患者氧合指数高于对照组(F=793.218,P<0.05),而肺内分流率(Qs/Qt)低于对照组(F=549.716,P<0.05)。在T2~T4时间点,对照组患者SvO_(2)、rSO_(2)较术前明显下降,同时伴随Ca-vO_(2)、CERO_(2)升高,而SGB组患者SvO_(2)、rSO_(2)及Ca-vO_(2)、CERO_(2)较术前无明显变化。在T2、T3时点,SGB组患者SvO_(2)、rSO_(2)较对照组高(P<0.05),而Ca-vO_(2)、CERO_(2)较对照组低(P<0.05)。SGB组中2例患者出现单侧喉返神经阻滞症状,1例患者出现臂丛神经阻滞,均未予特殊处理,于术后24 h内好转。两组均未出现严重肺部并发症。结论超声引导下SGB有助于减少单肺通气期间的肺内分流,改善术中氧合和脑氧代谢,具有一定的脑保护作用。Objective To observe the impact of ultrasound-guided stellate ganglion block(SGB)on intrapulmonary shunt and cerebral oxygen metabolism in elderly patients undergoing single-lung ventilation.Methods Ninety-six elderly patients who underwent thoracic surgery under one lung ventilation at Suzhou Hospital Affiliated to Nanjing Medical University from April 2020 to October 2022 were selected.Among them,48 patients received SGB on the ventilation side under ultrasound guidance before general anesthesia(SGB group),and the remaining 48 patients did not receive SGB(control group).At the immediate start of the procedure(T0),before single-lung ventilation(T1),15 min(T2),30 min(T3),60 min(T4)after single-lung ventilation,and 15 min after resumption of two-lung ventilation(T5),the patient's physiological indices,including the mean arterial pressure(MAP)and heart rate(HR),were monitored and recorded;arterial and jugular venous blood gases were analyzed to obtain pulmonary shunt fractionn(Qs/Qt)and oxygenation index(OI);Jugular venous oxygen saturation(SvO_(2))and obstructed side cerebral oxygen saturation(rSO_(2))were recorded,and cerebral oxygen consumption rate(CERO_(2))was calculated.Complications related to SGB and postoperative pulmonary complications within 72 hours were documented.T test or analysis of variance was used for measurement data,and Chi-square test was used for counting data.Results A total of 93 patients were ultimately included in the statistical analysis,including 46 in the SGB group and 47 in the control group.The SGB group exhibited lower HR and more stable MAP during surgery compared with the control group(F=333.662,P<0.05).After single-lung ventilation,both groups showed significantly increased intrapulmonary shunt.OI in the SGB group was higher,and Qs/Qt was lower than the control group at T2-T5(F=793.218,549.716;P<0.05).At time points T2 to T4,the control group showed a significant decrease in SvO_(2)and rSO_(2)compared with preoperative values,accompanied by an increase in Ca-vO_(2)and CERO_(2).In

关 键 词：星状神经节阻滞 超声引导 单肺通气 肺内分流 脑氧代谢 

分 类 号：R614[医药卫生—麻醉学]