星状神经节阻滞对心肺转流脑损伤的影响

Influence of stellate ganglion block on cerebral injury during cardiopulmonary bypass

目的 探讨星状神经节阻滞（SGB）对心肺转流（CPB）脑损伤的影响.方法 择期二尖瓣置换术患者40例,随机分为观察组（S组）和对照组（C组）,每组20例.S组麻醉诱导前行右侧SGB,C组未处理.于气管插管即刻（T1）、CPB后停止降温后5 min（T2）、CPB复温至36℃时（T3）、CPB结束后1 h（T4）测定颈静脉血氧饱和度（SjvO2）,同时于各时点及CPB结束后6 h（T3）、24 h（T6）检测颈静脉血S-100蛋白及神经元特异性烯醇化酶（NSE）浓度.于术前1 d、术后第1天和第2天行简易智力量表（MMSE）测定.结果 T2时,两组SjvO2较T1时均升高（P〈0.05）;T3时明显降低（P〈0.05）;但S组波动幅度小于C组（P〈0.05）;T2、T3时两组MAP较T1时降低（P〈0.01）.T2～T5时两组S-100蛋白和NSE浓度较T1时均显著升高（P〈0.05或P〈0.01）;但S组升高幅度小于C组（P〈0.05）.C组术后第1天MMSE评分低于术前1 d（P〈0.05）.结论 SGB可改善并稳定CPB时颈静脉血氧合,减缓血S-100蛋白及NSE水平上升,对CPB患者具有一定的脑保护作用.

Objective To investigate the influence of stellate ganglion block （SGB） on cardiopulmonary bypass （CPB）-induced cerebral injury. Methods Forty patients underwent selective mitral value replacement were randomized into two groups with 20 eases each. The patients in group S received right-lateral SGB before anesthesia induction and those in group C were not as the controls. Jugular blood oxygen saturation（SjvO2 ） was measured immediate after tracheal intubation, at 5 min after reaching a stable hypothermia after CPB, time of rewarming to 36℃and 1 h after CPB. Plasma levels of S-100 protein and （NSE） were detected at the time points mentioned above and 6 h and 24 h after CPB. （MMSE） was performed one day before,on the 1st and 2nd day after operation. Results SjvO2 increased in both groups during CPB,but the increase of SjvO2 was less in group S than that in group C（P（0. 05）. So did the plasma levels of S-100 and NSE（P〈0. 05 或 P〈0.01）. MMSE score in group C was lower on the 1st postoperative day than that before（P〈0. 05）. Conclusion SGB may improve and stabilize the jugular blood oxygen saturation, and protect the brain from CPB-induced injury through attenuating the increase of blood S-100 and NSE.