星状神经节阻滞稳定全麻气管内插管及切皮时应激反应的初步研究

Effect of Stellate Ganglionic Block on Endocrine Changes at Tracheal Intubation and Incision with General Anesthesia

为观察应用星状神经节阻滞 (SGB)后全麻诱导气管内插管及手术切皮时内分泌的变化 ,将神经外科择期手术病人按麻醉方法的不同 ,分为阻滞组 (S组 ,n =1 4 ,于麻醉诱导前 5min行左SGB)与对照组 (N组 ,n =1 4 )进行对比观察。测量入室 (t0 )、气管插管后 1min(t1)、手术开始切皮 (t2 ) 3个时间的血浆皮质醇 (COR)、催乳素 (PRL)和胰岛素 (INS)浓度以及收缩压 (SBP)、舒张压 (DBP)和心率 (HR)。结果 :S组 3个时间的COR及PRL呈下降趋势、INS呈上升趋势 ;N组 3个时间的COR及PRL呈上升趋势、INS呈下降趋势 ;且SBP、HR、COR和PRL组内差比较均为N组 >S组 (P <0 .0 5和P <0 .0 1 )。显示SGB后诱导气管内插管及切皮时的SBP、HR及COR、PRL和INS变化相对较小。提示全麻诱导前行SGB具有抑制气管内插管及手术切皮时应激反应和稳定血流动力学的作用。

To observe the effect of SGB on endocrine changes at tracheal inubation and incision with general anesthesia and to estimate the effect of cervical sympathetic block on regulating and controlling the stress response during this period of time.Twenty eight ASAⅠ～Ⅱ patients for selective neurosurgery were randomly divided into two groups: Group S contains patients who received left SGB five minutes before induction, while Group N as negetive controll is comprised of those who did not receive SGB.Blood specimens were taken to measure the concentration of plasma corticosteroids, prolactin and insulin before anesthesia induction( t 0), after tracheal indubation ( t 1),and at the time of incision( t 2). The patients were induced with fentanyl, pancuroniun, and propofol before tracheal intubation.The results showed that concentrations of COR and PRL decreased while INS increased in group S; Concentrations of COR and PRL increased; while INS decreased in group N. Plama level of COR and PRL in group N significantly increased in comparison with group S( P <0.05, P <0.01). Conclusion: Changes of COR, PRL and INS were relatively smaller after SGB during tracheal intubation and incision with general anesthesia which suggest that SGB before induction effectively suppress the stress response during tracheal intubation and incision in general anesthesia work as stable blood dynamics.