星状神经节阻滞联合全凭静脉麻醉在急性胆囊炎患者手术中的效果

Effect of Stellate Ganglion Block Combined with Total Intravenous Anesthesia in Patients with Acute Cholecystitis

目的 观察急性胆囊炎手术患者接受星状神经节阻滞联合全凭静脉麻醉的麻醉效果。方法 选取2018年1月至2021年12月于新密市中医院接受手术治疗的115例急性胆囊炎患者为研究对象,依据随机数字表法将其分为对照组(57例)与观察组(58例),对照组接受全凭静脉麻醉,观察组接受星状神经节阻滞联合全凭静脉麻醉,观察两组术前5 min、插管时、切皮时、胆囊切除时、手术结束时血流动力学指标(舒张压、收缩压、心理、血氧饱和度),对比两组术后6、24 h时血清疼痛递质[神经肽Y(NPY)、β-内啡肽(β-EP)、5-羟色胺(5-HT)],并统计两组不良反应发生情况。结果 插管时、切皮时、胆囊切除时、手术结束时,两组舒张压、收缩压均降低,心率均加快(P<0.05),观察组舒张压、收缩压高于对照组,心率低于对照组(P<0.05);术后6、24 h时观察组NPY、β-EP、5-HT水平均低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论 星状神经节阻滞联合全凭静脉麻醉可稳定急性胆囊炎手术患者血流动力学,减少血清疼痛递质释放,且不会增加不良反应。

Objective To observe the anesthetic effect of stellate ganglion block combined with total intravenous anesthesia in patients with acute cholecystitis.Methods A total of 115 patients with acute cholecystitis who underwent surgery in Xinmi Hospital of Traditional Chinese Medicine from January 2018 to December 2021 were selected as the research subjects.They were divided by the random number table method into control group(57 cases)and observation group(58 cases).The control group received total intravenous anesthesia,and the observation group received stellate ganglion block combined with total intravenous anesthesia.The hemodynamic indexes(diastolic blood pressure,systolic blood pressure,psychology and blood oxygen saturation)were observed five minutes before operation,during intubation,at skin incision,cholecystectomy and the end of operation,the serum pain mediators[neuropeptide Y(NPY),β-endorphin(β-EP)and 5-hydroxytryptamine(5-HT)]of both groups 6 and 24 hours after operation were compared,and the occurrence of adverse reactions in both groups were counted.Results During intubation,at skin incision,cholecystectomy and the end of operation,the diastolic and systolic blood pressure were decreased and the heart rate were increased in both groups(P<0.05).Compared with the control group,the diastolic and systolic blood pressure in the observation group were higher and the heart rate was lower(P<0.05).Compared with the control group,NPY,β-EP and 5-HT in the observation group 6 and 24 hours after operation were lower,there was a statistical significant difference(P<0.05).Compared the incidence of adverse reactions in both groups,there was no statistical significant difference(P>0.05).Conclusion Stellate ganglion block combined with total intravenous anesthesia can stabilize the hemodynamics of patients with acute cholecystitis,reduce the release of serum pain mediators,and will not increase adverse reactions.