星状神经节阻滞对颅脑外伤急诊手术患者术中胃黏膜pHi的影响

Effects of Stellate Ganglion Block on Gastric Intramucosal pHi in Acute Intracranial Surgical Patients with Craniocerebral Trauma

目的:研究右侧星状神经节阻滞(SGB)对颅脑外伤急诊手术患者术中胃黏膜pH值(pHi)的影响。方法:40例颅脑外伤需要急诊手术患者按Glasgow评分(GCS)均分为2个组,GCS≥8分为轻中度组(Q组),GCS<8分为重度组(Z组);每组又随机均分为右侧星状神经节阻滞(S亚组)和对照(C亚组)2个亚组,共得到QS、QC、ZS、ZC4个亚组,每组10例。全麻平稳后QS、ZS亚组和QC、ZC亚组分别用0.25%布比卡因10mL和0.9%氯化钠液10mL进行右星状神经节阻滞干预,比较干预前(T0)、术中1h(T1)、手术结束时(T2)和手术结束后1h(T3)胃黏膜pHi的变化。结果:QC亚组各时点pHi比ZC亚组相应时点高;QS、ZS亚组T1～T3时点pHi比同亚组T0时点高,也比对照的QC、ZC亚组相应时点高;pHi增加的幅度ZS亚组比QS亚组高。结论:颅脑外伤患者术中胃黏膜pHi均降低,且降低程度与颅脑外伤程度正相关;SGB能改善其术中胃黏膜pHi,且颅脑外伤程度越重改善效果越明显。

Objective：To study the effects of right stellate ganglion block on gastric intramucosal pHi in acute intracraniaI surgical patients with cerebral trauma. Methods：Forty patients with cerebral trauma undergoing emergency surgery were allocated to mild or moderate degree group（Q group,n=20）and severe degree group（Z group,n=20）according to Glasgow scores. They were randomly divided into stellate ganglion block（S subgroup）and control group（C subgroup）. There were four subgroups（QS、QC、ZS、ZC,n=10 in each subgroup respectively）totally. 0.25% bupivacaine solution or 0.9% Sodium chloride injection 10mL were injected locally at right stellate ganlion after anesthesia. Gastric intramucosal pHi before intervention（T0）,at 1hour during operation（T1）,at the end of operation（T2） and 1 hour after surgery（T3）were compared. Results：QC subgroup at every time point had significantly higher pHi values than QC subgroup. The pHi values of QS and ZS subgroup from T1 to T3 were significantly higher than those of the same subgroup at T0 and those of each control QC and ZC subgroup at corresponding time point. As to the increase amplitude,the ZS subgroup was superior to the QS subgroup. Conclusion：Gastric intramucosal phi values decreases in patients with cerebral trauma and the decrease amplitude is related to the degree of cerebral trauma positively. SGB improves pHi values in an injury severity dependent manner.