超声引导下SGB复合全麻对老年胃肠手术患者胃肠道功能、炎症因子及应激反应的影响

Effects of ultrasound-guided stellate ganglion block combined with general anesthesia on gastrointestinal function,inflammatory factors and stress response in the elderly patients undergoing gastrointestinal surgery

目的探讨超声引导下星状神经节阻滞(SGB)复合全麻对老年胃肠手术患者胃肠道功能、炎症因子及应激反应的影响。方法选择2018年3月至2020年3月厦门大学附属中山医院麻醉科行胃肠手术的100例老年患者进行研究,根据随机数字表法将其分为对照组和观察组,每组各50例。对照组患者采用全麻,观察组患者给予超声引导下SGB复合全麻。比较两组患者在术后2 d胃肠道功能,术前、术后2 d炎症因子[血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)]及应激反应指标[丙二醛(MDA)、超氧化物歧化酶(SOD)、皮质醇(CORT)]的变化情况,并记录术后并发症的发生情况。结果术后,观察组患者的排便时间、肛门排气时间、肠鸣音恢复时间、首次进食时间分别为(38.98±7.41)min、(33.64±4.13)min、(24.18±7.02)min、(33.16±5.04)min,均明显短于对照组的(46.10±8.19)min、(51.81±5.07)min、(30.64±6.41)min、(54.29±4.91)min(P<0.001)。术后,观察组患者的CRP、TNF-α、IL-6、MDA、SOD、CORT水平均明显低于对照组,差异有统计学意义(P<0.001)。观察组患者术后并发症总发生率为4.00%,明显低于对照组的18.00%(P<0.05)。结论超声引导下SGB复合全麻可促进老年胃肠手术患者的胃肠道功能恢复,减少炎症反应和应激反应的表达水平,有利于患者的预后,值得临床推广。

Objective To investigate the effect of ultrasound-guided stellate ganglion block(SGB)combined with general anesthesia on gastrointestinal function,inflammatory factors and stress response in elderly patients undergoing gastrointestinal surgery.Methods A total of 100 elderly patients who underwent gastrointestinal surgery in the Department of Anesthe from Zhongshan Hospital Xiamen University from March 2018 to March 2020 were selected for the study.According to the random number table method,the patients were divided into a control group and an observation group,with 50 cases in each group.Patients in the control group were treated with general anesthesia,and patients in the observation group were given SGB combined ultrasound-guided general anesthesia.The gastrointestinal function two days after surgery,and changes in the inflammatory factors(serum C-reactive protein[CRP],tumor necrosis factor-α[TNF-α]and interleukin-6[IL-6])and stress response indicators(malondialdehyde[MDA],superoxide dismutase[SOD],cortisol[CORT])two days before and after the surgery were compared between the two groups.The occurrence of postoperative complications was recorded.Results After the surgery,the defecation time,anal exhaust time,bowel sound recovery time,and first food intake time in the observation group were(38.98±7.41)min,(33.64±4.13)min,(24.18±7.02)min,and(33.16±5.04)min,respectively,which were significantly shorter than those of(46.10±8.19)min,(51.81±5.07)min,(30.64±6.41)min,and(54.29±4.91)min,respectively in the control group(P<0.001).After the surgery,the levels of CRP,TNF-α,IL-6,MDA,SOD,and CORT in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.001);the total postoperative complication rate in the observation group was 4.00%,which was significantly lower than that of 18.00%in the control group(P<0.05).Conclusion Ultrasound-guided SGB combined with general anesthesia can promote the recovery of gastrointestinal function in elderly patients undergoing gastrointestinal surgery and reduce the expression level of inflammatory response and stress response,which is beneficial to the prognosis of patients and is worthy of clinical promotion.