| 贾莲明,胡引芳,余文富.超声引导下星状神经节阻滞对老年腹腔镜胆囊切除术脑部血液灌注和认知功能的影响[J].安徽医药,2020,24(10):2058-2063. |
| 超声引导下星状神经节阻滞对老年腹腔镜胆囊切除术脑部血液灌注和认知功能的影响 |
| Impact of ultrasound?guided stellate ganglion block on blood perfusion and cognitive function in elderly patients undergoing laparoscopic cholecystectomy |
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| DOI：10.3969/j.issn.1009?6469.2020.10.036 |
| 中文关键词: 自主神经传导阻滞 星状神经节 胆囊切除术，腹腔镜 老年人 认知功能 脑氧代谢 )。两，高于， |
| 英文关键词: Autonomic nerve block Stellate ganglion Cholecystectomy,laparoscopic Aged Cognitive function Cere? bral oxygen metabolism |
| 基金项目: |
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| 中文摘要: |
| 目的观察超声引导下星状神经节阻滞对胆囊切除术老年病人脑部血液灌注和认知功能的影响。方法选择 2017年 1月至 2018年 12月在上海电力医院就诊行胆囊切除术的老年病人 130例，按照随机数字表法，将病人分为观察组和对照组，每组各 65例。对照组使用普通全麻，观察组在对照组的基础上行星状神经节阻滞(SGB)。在进入手术室时(T0)、气管插管时(T1)、建立气腹时(T2)、胆囊切除即刻(T3)和气管拔除时(T4)各个时点，比较两组平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、颈内静脉球部血氧饱和度(SjvO2)、桡动脉 ?颈内静脉球部血氧含量差值(Da?jvO2)、脑氧摄取率(CEO2)、葡萄糖摄取率(GluER)、脑乳酸生成率(LacPR)和 β?淀粉样多肽 ?42(Aβ?42)水平的变化；比较两组自主呼吸恢复时间、拔管时间、苏醒时间和抬头时间及两组在术前、术后 1d、3d、5d和 7d的简易智力状态量表(MMSE)和视觉模拟疼痛评分(VAS)水平。结果观察组的自主呼吸恢复时间(2.76±1.38)min、拔管时间(8.09±2.37)min、苏醒时间(11.61±3.62)min和抬头时间(16.34±2.49)min明显短于对照组(3.48±1.63)、(9.68±2.55)、(13.53±4.18)、(18.68±3.18)min(均 P＜0.01)。两组术前 MMSE和 VAS水平差异无统计学意义(P＞0.05)术后 1d两组的 MMSE水平均较术前显著降低(P＜0.01)，术后 3～7d两组 MMSE水平均较术后 1d出现显著上升(P＜0.01)而观，察组的 MMSE上升幅度较对照组更为显著(P＜0.01)；术后 1d两组 VAS水平较术前显著升高(P＜0.01)术后 3～7d的 VAS水平较术后 1d出现显著下降(P＜0.01)，而观察组的 VAS降低幅度较对照组更为显著(P＜两组，0.01组在 T0时点的 MAP、HR、SjvO2、Da?jvO2、CEO2、GluER、LacPR和 Aβ?42差异无统计学意义(P＞0.05)麻醉后对照组 T1~T4时点的 MAP、GluER和 LacPR水平明显低于同组 T0时点及观察组(P＜0.01)，而 HR在 T1~T4时点明显T0和观察组(P＜0.01)；观察组 SjvO2在 T1~T4时点的较 T0和对照明显升高(P＜0.01)；观察组的 Da?jvO2和 CEO2在 T1~T4时点较 Da?jvO2和 CEO2T0时点和对照组明显降低(P＜0.01)；两组 T1~T4时点的 Aβ?42水平较 T0时点出现明显升高(P＜0.01)，而观察组的升高幅度低于对照组(P＜0.01)。而在 T1~T4时点两组 SpO2水平与 T0比较差异无统计学意义(P＞0.05)。结论超声引导下星状神经节阻滞对老年病人全麻腹腔镜胆囊切除术的血液动力学具有稳定作用，有助于改善脑部的血液灌注和能量代谢，对术后认知功能障碍具有明显的缓解作用。 |
| 英文摘要: |
| Objective To observe the impact of ultrasound?guided stellate ganglion block on blood perfusion and cognitive functionin elderly patients with cholecystectomy.Methods A total of 130 elderly patients who underwent cholecystectomy in ShanghaiElectric Power Hospital from January 2017 to December 2018 were divided into observation group and control group according tothe random number table，with 65 cases in each group.The control group performed with general anesthesia and the observationgroup was given the stellate ganglion block(SGB)on the basis of the control group.The mean arterial pressure(MAP)，heart rate(HR)，pulse oxygen saturation(SpO2)jugular venous oxygen saturation(SjvO2)，difference in arterial?jugular bulb oxygen content(Da?jvO2)，cerebral extraction of oxygen(，CEO2)，glucose uptake rate(GluER)，cerebral lactate production rate(LacPR)and amy? loid β?42(Aβ?42)levels in the two groups were compared at each time point of entering the operating room(T0)，tracheal intuba? tion(T1)，establishing pneumoperitoneum(T2)，immediate cholecystectomy(T3)and tracheal extraction(T4)； the spontaneous breathing recovery time，extubation time，awakening time and head?up time in the two groups were also compared and the mini?men? tal state examination(MMSE)andvisual analogue score(VAS)levels were compared in the two groups by day 1，day 3，day 5 and day7 after surgery.Results The spontaneous breathing recovery time(2.76±1.38 vs.3.48±1.63)min，extubation time(8.09±2.37 vs.9.68±2.55)min，awakening time(11.61±3.62 vs.13.53±4.18)min and head?up time(16.34±2.49 vs.18.68±3.18)minin the obser? vation group were significantly shorter than those in the control group(P＜0.01).There was no significant difference in the levels of MMSE and VAS between the two groups before surgery(P＞0.05)，the MMSE levels in the two groups by day1 after surgery were significantly lower than those before surgery(P＜0.01)，the MMSE levels in the two groups by day 3?7 after surgery were sig? nificantly higher than those by day 1 after surgery(P＜0.01)，while the increasing levels in the observation group was more obvi? ous than those in the control group(P＜0.01)； the VAS levels in the two groups by day 1 after surgery were significantly higher than those before surgery(P＜0.01)，the VAS levels in the two groups by day 3?7 after surgery were significantly lower than those by day 1 after surgery(P＜0.01)，while the decrease of VAS in the observation group was more obvious than that in the control group(P＜0.01).There were no significant differences in MAP，HR，SjvO2，Da?jvO2，CEO2，GluER，LacPR and Aβ?42 between the two groups at T0(P＞0.05)，after anesthesia，the levels of MAP，GluER and LacPRin control group at T1?T4 were significantly low? er than those at T0 and in the observation group(P＜0.01)while the HR levels in the control group at T1?4 were significantly higher than thoseat T0 and in the observation group(P＜0.01)，；the levels ofSjvO2in the observation group at T1?T4 were signifi? cantly higher compared with those at T0 and in the control group，the levels of Da?jvO2 and CEO2at T1?T4 in the observation group were significantly lower than those at T0 and in the control group(P＜0.01)，and the levels of Aβ?42 in the two groups at T1?4 were higher than at T0(P＜0.01)，while the increasing levels in the observation group were lower than those in the control group(P＜0.01).There was no significant difference of SpO2 in the two groups at each time point(P＞0.05).Conclusion Ultrasound? guided stellate ganglion block has a stable effect on the hemodynamics in elderly patients with cholecystectomy，which can improve brain blood perfusion and energy metabolism in the brain，and relief postoperative cognitive dysfunction. |
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