星状神经节阻滞对原发性睡眠障碍患者夜间睡眠质量的影响

Effect of stellate ganglion block on nighttime sleep quality in patient with primary sleep disorder

目的评价星状神经节阻滞对原发性睡眠障碍患者夜间睡眠质量的影响。方法原发性睡眠障碍患者60例,性别不限,年龄18~64岁,体重40~75 kg,ASA分级Ⅰ或Ⅱ级。采用随机数字表法分为2组(n=30):对照组(C组)和星状神经节阻滞组(S组)。S组于睡前1 h在超声引导下右侧颈长肌表面星状神经节所在位置注射0.2%罗哌卡因5 ml,C组注射等容量生理盐水,1次/d,连续7 d。于治疗前1 d(T0)和治疗1-7 d(T1-7)时采用匹兹堡睡眠质量指数(PSQI)问卷量表评价患者的主观睡眠质量,多导睡眠监测仪评价患者客观睡眠质量,BIS监测仪及脑部与区域血氧监测系统监测睡眠期间BIS值及局部脑氧饱和度(rSO2),每30 min记录1次,计算7 d平均值。于治疗结束后连续3 d(T8-10)评估患者日间高级认知功能,包括持续性注意力测验(CPT)和执行缺陷综合征的行为学测验(BADS),计算3 d平均值。分别于T0和T8时采集静脉血样,采用高效液相色谱法检测血浆去甲肾上腺素(NE)、皮质醇和5-羟色胺浓度。结果与C组比较,S组治疗期PSQI各单项评分及总分均降低,睡眠潜伏期、觉醒时间和快波睡眠潜伏期缩短,觉醒次数增加,总睡眠时间延长,睡眠效率和快波睡眠比例升高,慢波睡眠S1-S2比例降低,S3-S4比例升高,BIS值降低,rSO2升高,治疗后CPT各指标降低,BADS各指标升高,T8时血浆NE浓度降低(P<0.05)。结论星状神经节阻滞可显著改善原发性睡眠障碍患者夜间睡眠质量。

Objective To evaluate the effect of stellate ganglion block on nighttime sleep quality in the patients with primary sleep disorders.Methods Sixty patients of both sexes with primary sleep disorders,of American Society of Anesthesiology physical statusⅠorⅡ,aged 18-64 yr,weighing 40-75 kg,were randomized to 2 groups(n=30 each):control group(group C)and stellate ganglion block group(group S).In group S,0.2%ropivacaine 5 ml was injected into the surface of the right longus colli muscle where the the stellate ganglion was located under ultrasound guidance once a day for 7 consecutive days starting from 1 h before bedtime.While the equal volume of normal saline was given instead in group C.Patients′Subjective Sleep Quality was assessed using the Pittsburgh Sleep Quality Index Questionnaire before treatment(T0)and 1-7 days after treatment.The objective sleep quality was evaluated with polysomnography.A bispectral index(BIS)monitor and a cerebral and regional blood oxygen monitoring system were used to monitor the BIS value and regional cerebral oxygen saturation(rSO2)during sleep,which were recorded once every 30 min,and the 7-day average was calculated.The patients′daytime advanced cognitive function was assessed for 3 consecutive days after the end of treatment(T8-10),including the Continuous Attention Test and the Behavioral Test for Performing Defect Syndrome,and the 3-day average value was calculated.Venous blood samples were collected at T0 and T8 to measure the plasma noradrenaline,cortisol,and serotonin concentrations by high-performance liquid chromatography.Results Compared with group C,the individual and total scores of Pittsburgh Sleep Quality Index were significantly decreased,the sleep latency,awakening time and fast wave sleep latency were shortened,the number of awakening was increased,the total sleep time was prolonged,the sleep efficiency and proportion of fast wave sleep were increased,S1-S2 ratio in slow-wave sleep was decreased,S3-S4 ratio was increased,BIS value was decreased,rSO2 was increased,each parameter of Continuous Attention Test was decreased and each parameter of Behavioral Test for Performing Defect Syndrome was increased after treatment,and plasma noradrenaline level was decreased at T8 in group S(P<0.05).Conclusion Stellate ganglion block can improve nighttime sleep quality in patients with primary sleep disorders.