星状神经节阻滞对重症急性胰腺炎患者肺损伤的影响

Effect of stellate ganglion block on severe acute pancreatitis complicated with acute lung injury

目的探讨星状神经节阻滞对重症急性胰腺炎(SAP)合并急性肺损伤(ALI)患者炎症介质及功能的影响。方法选取2016年6月—2018年12月河北北方学院附属第一医院重症医学科确诊SAP患者34例,随机分为常规治疗组(对照组)19例和超声引导下星状神经节阻滞组(SGB组)15例。对照组予禁食、水等常规治疗,而SGB组在常规治疗基础上行超声引导下星状神经节阻滞。酶联免疫吸附试验检测TNF-α、IL-1β、IL-6、IL-10的变化,血液细胞分析法检测CRP和WBC的水平。观察两组在治疗前后肺水指数、氧合指数、治疗后ICU住院时间及呼吸机拔管时间的差异,以及入院0 h(T0)、第3天(SGB治疗后2 d,T1)、第7天(SGB治疗后6 d,T2)和第15天(SGB治疗后14 d,T3)时间点炎症介质的改变。结果治疗前两组患者肺水指数和氧合指数比较,差异无统计学意义(P>0.05)。治疗2周后SGB组的肺水指数较对照组下降(P<0.05),氧合指数较对照组升高(P<0.05),SGB组ICU住院时间、呼吸机拔管时间较对照组缩短(P<0.05)。不同时间点间IL-6、TNF-α、IL-1β、IL-10、WBC和CRP有差异(P<0.05);两组患者IL-6、TNF-α、IL-1β、CRP和IL-10有差异(P<0.05);两组患者TNF-α、IL-1β、IL-10、WBC、CRP随时间变化趋势有差异(P<0.05)。结论SGB有可能减轻SAPALI的炎症反应而利于改善肺损伤。

Objective To analyze the effects of stellate ganglion block(SGB)on inflammatory factors and lung function in severe acute pancreatitis(SAP)complicated with acute lung injury(ALI).Methods A total of 34 cases of severe acute pancreatitis patients in intensive care unit(ICU)department of the first affiliated hospital of Hebei northern university from June 2016 to December 2018 were recruited,which randomly divided into 19 cases with routine treatment group(control group)accepted critical care associated treatment and 15 cases with ultrasoundguided stellate ganglion block combined with routine treatment group(SGB group).Enzyme linked immunosorbent assay was used to detect the changes of TNF-α,IL-1β,IL-6,IL-10,and blood cell analysis was applied to examine the level of C reactive protein(CRP)and white blood cell(WBC).The differences of lung water index and oxygenation index between pre-and post-treatment,the length of ICU duration,the time of tracheal extubation,and the change of inflammatory factors in T0,T1,T2,T3 admitted into ICU between SGB group and control group were observed.Results In pre-treatment,there was no difference in the level of lung water index and oxygenation index between two groups(P>0.05).2 weeks after treatment,compared with control group,the level of lung water index was decreased and the level of oxygenation index was increased significantly in SGB group(P<0.05),meanwhile,the length of ICU duration and the time of tracheal extubation were less in SGB group(P<0.05).Contrasted with control group,the level of IL-6,TNF-α,IL-1β,IL-10,WBC and CRP in T0,T1,T2,T3 were significantly different(P<0.05).Meanwhile,compared to control group,the level of IL-6,TNF-α,IL-1β,CRP and IL-10 were different in the time of T2(P<0.05),and the time related change trends of TNF-α,IL-1β,IL-10 and WBC,CRP were significantly distinctive(P<0.05).Conclusion SGB may alleviate lung injury by regulating inflammatory factors in SAP-ALI.