超声引导星状神经节阻滞对患者全身麻醉期间血流动力学的影响

Effect of Ultrasound-Guided Stellate Ganglion Block on Hemodynamics in Patients during General Anesthesia

目的观察超声引导星状神经节阻滞对患者全身麻醉期间血流动力学的影响。方法选择择期行眼眶下壁骨折修复手术患者(ASA分级Ⅰ或Ⅱ级) 60例,采用随机数字表法随机分为A、B、C组,每组20例。A组和B组分别给予超声引导和盲探星状神经节阻滞后行全麻诱导经口气管插管术,C组无操作仅行全麻诱导经口气管插管术。3组采用相同的麻醉诱导药物及剂量,观察并记录3组患者入室(基础值,T_0)、全麻诱导后(T_1)、气管导管进入声门即刻(T_2)、插管后1 min (T_3)、插管后5 min (T_4)、切皮即刻(T_5)、手术结束后清醒时(T_6)、气管导管拔除即刻(T_7)、气管导管拔除后5 min (T_8)的收缩期动脉血压(SBP)、舒张期动脉血压(DBP)、平均动脉压(MAP)、心率(HR)、心率与收缩压乘积(RPP)及血氧饱和度(SpO_2)。记录A、B 2组行星状神经节阻滞后出现霍纳综合征的例数及血管损伤、声音嘶哑等并发症的发生情况。结果 3组患者一般情况及各时点SpO_2无统计学差异(P> 0.05);在T_2、T_3、T_4、T_5、T_6、T_7、T_8时点,与A、B组比较,C组SBP、DBP、MAP、RPP明显升高,HR明显增快(P <0.05)。B组星状神经节阻滞后出现霍纳综合征15例,并发症4例,其中声音嘶哑3例,血管损伤1例。结论超声引导星状神经节阻滞在眼眶下壁骨折患者全麻期间可有效减少麻醉诱导、术中及拔管过程中血流动力学波动,较盲探星状神经节阻滞成功率高,安全、并发症少。

Objective To observe the effect of ultrasound-guided stellate ganglion block(SGB)on hemodynamics during general anesthesia.Methods Sixty patients undergoing internal fixation of orbital floor fracture(ASA gradeⅠ/Ⅱ),were divided into groups A,B,and C with a random number table(n=20 per group).Groups A and B were respectively treated with ultrasound-guided SGB and blind SGB before general anesthesia.Group C was solely treated with general anesthesia.Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),heart rate(HR),rate-pressure product(RPP)and saturation of peripheral oxygen(SpO2)were recorded at 9 time points including entering operation room(the foundation value,T0),after induction of anesthesia(T1),immediately after intubation(T2),1 min after intubation(T3),5 min after intubation(T4),skin incision(T5),recovery after the end of surgery(T6),immediately after extubation(T7)and 5 min after extubation(T8).The number of patients who exhibited Horner’s syndrome after SGB and the incidence of adverse reactions were recorded.Results No differences existed in demographic characteristics among the three groups(P>0.05).There were no changes in SpO2 in the three groups;SBP,DBP,MAP,RPP,and HR significantly increased in group C,compared with groups A and B(P<0.05).Fifteen patients exhibited Horner’s syndrome after SGB;4 patients had complications.Conclusion Ultrasound-guided SGB in the treatment of inferior orbital floor fracture can reduce hemodynamic fluctuation during induction of anesthesia,surgery,and extubation.Ultrasound-guided SGB was safer and more accurate than blind SGB.