超声引导下单侧星状神经节阻滞预防胸腹腔镜食管癌根治术后心律失常的效果

Ultrasound-guided Unilateral Stellate Ganglion Block in Prevention of Arrhythmia after Thoraco-laparoscopic Radical Resection of Esophageal Carcinoma

目的探讨单侧星状神经节阻滞预防胸腹腔镜食管癌根治术后心律失常的效果。方法选取我院2020年3月至2021年3月拟行胸腹腔镜食管癌根治术患者120例,随机依次纳入单侧星状神经节阻滞组(unilateral stellate ganglion block group,U组)或空白对照组(control group,C组),最终每组各纳入58例患者。U组行超声引导下左侧星状神经节阻滞;C组患者不实施任何操作。根据术后24 h动态心电图结果评估患者心律失常发生情况。记录患者术后24 h内不良反应及神经阻滞相关并发症。结果两组患者手术时间、术中失血量、丙泊酚及瑞芬太尼用量比较均无统计学差异(P>0.05)。术后24 h内U组室上性心动过速、室性早搏的发生率显著低于C组,差异有统计学意义(P<0.05),两组患者术后24 h内传导阻滞发生率、PONV及头晕发生率比较,差异均无统计学意义(P>0.05),但U组患者声音嘶哑、上肢麻痹的发生率明显高于C组,差异有统计学意义(P<0.05)。U组所有患者均出现Horner综合征,但未见神经损伤、气胸、局部血肿、局部感染、局麻药中毒等严重并发症。结论超声引导下单侧星状神经节阻滞能够降低胸腹腔镜食管癌根治术后心律失常的发生率,但需警惕Horner综合征、上肢麻痹、声音嘶哑等星状神经节阻滞相关不良反应。

Objective To explore the effect of unilateral stellate ganglion block in prevention of postoperative arrhythmia after thoraco-laparoscopic radical resection of esophageal carcinoma.Methods120 cases aged from 18 to 65 years with ASAⅡtoⅢand BMI<27.9 kg/m^(2),planed to perform thoraco-laparoscopic radical esophagectomy in our hospital from March 2020 to March 2021 were divided randomly into unilateral stellate ganglion block group(group U)and blank control group(group C)according to a random number table.Finally,58 patients were enrolled in each group.Ultrasound-guided left stellate ganglion block was performed in the group U,and was not in the group C.The occurrence of arrhythmia was evaluated according to dynamic ECG of 24 hours after the operation,and adverse reaction and complication associated with nerve block was recorded.Results There were no significant differences in operation time,intra-operative blood loss and dosage of propofol and remifentanil between the two groups(P>0.05).The incidence of supraventricular tachycardia and premature ventricular contraction of the group U was significantly lower than those of the group C during 24 hours after the surgery(P<0.05).There was no remarkable difference in the incidence of conduction block,PONV and dizziness between the two groups within 24 hours after the operation,(P>0.05),but the incidence of hoarseness and upper limb paralysis was significantly higher in the group U than those in the group C,and the difference was statistically significant(P<0.05).Horner syndrome was found in all 58 cases of the Group U,but no serious complications such as nerve injury,pneumothorax,local hematoma,local infection and local anesthetic intoxicating were found.Conclusion Ultrasound-guided unilateral stellate ganglion block can reduce the incidence of postoperative arrhythmias after thoraco-laparoscopic radical resection of esophageal cancer,but adverse reactions related to stellate ganglion block such as Horner syndrome,hoarseness and upper limb paralysis should be paid more attention.