星状神经节阻滞对颅脑胶质瘤术中脑氧代谢的影响

Influence of stellate ganglion block on brain oxygen metabolism undergoing cerebral glioma operation

目的探讨星状神经节阻滞对颅脑胶质瘤术中脑氧代谢的影响。方法 ASAⅠ～Ⅱ级颅内胶质瘤择期切除的病人40例,年龄26～50岁,体质量指数18.5～25 kg/m2。随机分为星状神经节阻滞组(A组)和对照组(B组),每组20例;A组患者诱导前行星状神经节阻滞,B组不行阻滞,2组分别在阻滞前(T0)、诱导后15 min(T1)、手术后30 min(T2)、打开硬脑膜后60 min(T3)、术毕(T4)5个时点记录MAP、HR、CSFP,采集动静脉血进行血气分析,计算动脉血氧含量(CaO2),颈内静脉血氧含量(SjvO2),动静脉血氧含量差(Da-vO2)及脑氧摄取率(ERO2)。结果苏醒时间A组短于B组(P<0.05);星状神经节阻滞后T3、T4时刻,A组颅内压降低较B组差异有统计学意义(P<0.05);A组术中心率、平均动脉压表现平稳,并有轻度下降趋势,与B组比较差异有统计学意义,与T0时刻及B组相比,A组T1、T2、T3、T4时刻等脑氧代谢指标改善(P<0.05)。结论星状神经节阻滞用于颅脑胶质瘤手术,可以减轻患者颅内压,改善脑氧供。

Objective To investigate the effects of stellate ganglion block on brain oxygen metabolism undergoing cerebral glioma operation. Methods Forty ASA Ⅰ or Ⅱ elective resection of gliomas in intracranial, aged 26~50 years old, BMI 18. 5 ~25 kg/m2, were randomly divided into 2 groups（20 cases each group）： block group（group A）, Control group（group B）. Group A made stellate ganglion block before induction, group B no block. Blood sample were taken before block （T1）, after induction 15 min （T2）, after operation 30 min （T3）, after open dura 60 min （T4）, immediately after operation （TS）, recording MAP,HR,CSFP and calculating CaO2 ,CjvO2 ,Da-vO2 .ERO2. Results The time of analepsia was significantly in group A than group B （P〈0.05）. Intracranial pressure was significantly lower in group A than that in group B （P〈0.05） at T3 and T4. Group A steady in operation with HR, MAP and downtrend slightly in operation. Index of CjvO2, Da-vO2 and ERO2 improved in group A than those in group B at T1, T2, T3, T4, and were also better at other points than T1 in group A. Conclusion Stellate ganglion block can reduce ICP and improve brain oxygen metabolism for glioma operation.