超声引导下星状神经节阻滞对全麻沙滩椅位肩关节镜手术患者术中rSO2的影响

Effect of ultrasound-guided stellate-ganglion block on intraoperative regional cerebral oxygen saturation in patients undergoing arthroscopic shoulder surgery in beach chair position with general anesthesia

目的评价超声引导下星状神经节阻滞(SGB)对全麻沙滩椅位肩关节镜手术患者术中局部脑氧饱和度(rSO2)的影响。方法择期行全麻沙滩椅位肩关节镜手术患者40例,性别不限,年龄18~64岁,ASA分级Ⅰ级或Ⅱ级,采用随机数字表法分为2组(n=20):对照组(C组)和SGB组(S组)。术侧行超声引导下SGB,S组注射0.25%盐酸罗哌卡因6 ml,C组注射0.9%氯化钠溶液6 ml。SGB后改沙滩椅位,10 min后改平卧位行麻醉诱导,气管插管术后5 min改沙滩椅位开始手术。分别于入室平卧位5 min(T0)、SGB后沙滩椅位5 min(T1)、麻醉诱导后平卧位5 min(T2)、麻醉诱导后沙滩椅位即刻(T3)、麻醉诱导后沙滩椅位5、15和30 min(T4-6)时记录rSO2,记录术中大脑去饱和事件(rSO2从基线降低大于或等于20%或在15 s内降至55%以下)发生情况。结果2组各时点术侧和非术侧rSO2和术中大脑去饱和事件发生率比较差异无统计学意义(P>0.05)。结论超声引导下SGB对全麻沙滩椅位肩关节镜手术患者术中rSO2无影响。

Objective To evaluate the effect of ultrasound-guided stellate-ganglion block(SGB)on regional cerebral oxygen saturation(rSO2)in the patients undergoing arthroscopic shoulder surgery in the beach chair position(BCP)with general anesthesia.Methods Forty patients of both sexes,aged 18-64 yr,of American Society of Anesthesiologists physical statusⅠorⅡ,scheduled for elective arthroscopic shoulder surgery in the BCP with general anesthesia,were divided into 2 groups(n=20 each)using a random number table method:control group(group C)and SGB group(group S).SGB was performed on the operated side under ultrasound guidance,0.25%ropivacaine 6 ml was injected in group S,and 0.9%sodium chloride 6 ml was given in group C.Patients were turned to BCP after SGB,and 10 min later the patients were placed in the supine position for induction of anesthesia.The patients were turned to BCP at 5 min after tracheal intubation,and then the operation was started.The rSO2 was recorded at 5 min of supine position after entering the operating room(T0),5 min of BCP after SGB(T1),5 min after anesthesia induction(T2),immediately after BCP(T3),and at 5,15 and 30 min of BCP(T4-6).The development of cerebral desaturation events(defined as a decrease in rSO2≥20%from baseline values or as a decrease in rSO2 below 55%within 15 s)was recorded.Results There was no significant difference in rSO2 on the operated and non-operated sides and incidence of intraoperative brain desaturation events at each time point between the two groups(P>0.05).Conclusion Ultrasound-guided SGB had no effect on the intraoperative rSO2 in the patients undergoing arthroscopic shoulder surgery in the BCP with general anesthesia.