超声引导下右侧星状神经节阻滞对经皮扩张气管切开术患者应激反应的影响

Effects of ultrasound-guided right stellate ganglion block on stress response in patients undergoing percutaneous dilation tracheotomy

目的探讨超声引导下右侧星状神经节阻滞对经皮扩张气管切开术患者应激反应的影响.方法将62例喉部肿瘤患者按照随机数字表法分为研究组与对照组,各31例.两组均行气管切开,研究组在此基础上实施超声引导下右侧星状神经节阻滞,比较两组患者气管切开前5 min、置入气管内套管即刻的心率、平均动脉压水平.比较麻醉前、置入气管内套管5 min时两组血糖、皮质醇及促肾上腺皮质激素水平.结果 置入气管内套管即刻两组心率及平均动脉压水平均较气管切开前5 min显著升高(P<0.05或0.01),研究组显著低于对照组(P<0.01).置入气管内套管5 min时研究组血糖及皮质醇水平与麻醉前比较差异无统计学意义(P>0.05),促肾上腺皮质激素水平显著高于麻醉前(P<0.01),对照组血糖、皮质醇及促肾上腺皮质激素水平均显著高于麻醉前(P<0.01),且显著高于研究组(P<0.01).结论超声引导下右侧星状神经节阻滞可有效减少经皮扩张气管切开术中患者的应激反应,稳定血流动力学指标水平,值得推广应用.

Objective To observe the effects of ultrasound-guided right stellate ganglion block on stress response in patients undergoing percutaneous dilation tracheotomy.Methods 62 patients with laryngeal neoplasms were divided into experimental group and control group according to the random number table method,with 31 cases in each group.The patients in the two group were given tracheotomy,and experimental group was given ultrasound-guided right stellate ganglion block on this basis.The heart rate and mean arterial pressure were compared between the two groups at 5 min before tracheotomy and immediately after tracheal cannula insertion,and the levels of blood glucose,cortisol and adrenocorticotropic hormone were compared between the two groups before anesthesia and at 5 min of tracheal cannula insertion.The levels of blood glucose,cortisol,and adrenocorticotropic hormone were compared between the two groups before anesthesia and the insertion of an endotracheal tube for 5 minutes.Results The heart rate and mean arterial pressure immediately after tracheal cannula insertion in the two groups were significantly increased compared with those before tracheotomy(P<0.05 or 0.01),and the indexes in experimental group were significantly lower than those in control group(P<0.01).There were no significant differences in the levels of blood glucose and cortisol in experimental group at 5 min of tracheal cannula insertion compared with those before anesthesia(P>0.05),and the level of adrenocorticotropic hormone was significantly higher than that before anesthesia(P<0.01),and the levels of blood glucose,cortisol and adrenocorticotropic hormone in control group were significantly higher than those before anesthesia(P<0.01),and were significantly higher than those in experimental group(P<0.01).Conclusions Ultrasound-guided right stellate ganglion block can effectively reduce intraoperative stress response and and stabilize the levels of hemodynamic indicators of patients undergoing percutaneous dilation tracheotomy.Therefore it is worthy of promotion and application.