超声引导下右侧星状神经节阻滞对急性颅脑外伤伴神经源性心脏病患者术后转归的研究

Study on Postoperative Outcome of Ultrasound-guided Right Stellate Ganglion Block in Patients with Acute Craniocerebral Trauma and Neurogenic Heart Disease

目的探讨对于急性颅脑外伤并发神经源性心脏病患者,在急诊手术中应用右侧星状神经节阻滞(RSGB),能否有助于患者术后心肌损伤的转归。方法选取2022年6月-2023年6月入我院接受急诊手术的急性颅脑外伤并发神经源性心脏病患者122例,按照随机数字表法分为常规组(n=61)和RSGB组(n=61)。常规组按照一般全身麻醉进行,RSGB组在常规麻醉的基础上加用RSGB辅助麻醉,术后两组均按照脑血管疾病临床指南治疗。比较两组在术前1 h,术后6 h及术后7天的血清肌酸激酶(CK)、肌酸激酶同工酶(CM-MB)、B型钠尿肽(BNP)、心肌肌钙蛋白T(CTNT),以及NCM的发生时间和缓解时间。结果两组CK、CM-MB、BNP、CTNT均为先升高后降低,RSGB组CK、CM-MB、BNP、CTNT均低于常规组,差异有统计学意义(P<0.05);两组急性颅脑外伤后BHS发生时间比较,差异无统计学意义(P>0.05);RSGB组的NCM比常规组的缓解时间短,差异有统计学意义(P<0.05)。结论在急性颅脑外伤并发神经源性心脏病患者手术麻醉中使用RSGB可一定程度缓解患者心肌损伤,可有效改善患者的短期预后。

Objective To investigate whether the application of right stellate ganglion block(RSGB)in emergency surgery can contribute to the outcome of postoperative myocardial injury in patients with acute craniocerebral trauma and neurogenic heart disease.Methods A total of 122 patients with acute craniocerebral trauma and neurogenic heart disease who underwent emergency surgery in our hospital from June 2022 to June 2023 were selected and divided into conventional group(n=61)and RSGB group(n=61)according to the random number table method.The conventional group was treated with general general anesthesia,and the RSGB group was treated with RSGB assisted anesthesia on the basis of conventional anesthesia.After operation,both groups were treated according to the clinical guidelines of cerebrovascular disease.The serum creatine kinase(CK),creatine kinase isoenzyme(CM-MB),B-type natriuretic peptide(BNP),cardiac troponin T(CTNT)at 1 h before operation,6 h after operation and 7 days after operation,the occurrence time and remission time of NCM were compared between the two groups.Results The levels of CK,CM-MB,BNP and CTNT in the two groups increased first and then decreased.The levels of CK,CM-MB,BNP and CTNT in the RSGB group were lower than those in the conventional group,and the differences were statistically significant(P<0.05).The NCM of the RSGB group was shorter than that of the conventional group,and the difference was statistically significant(P<0.05).Conclusion RSGB in surgical anesthesia for patients with acute craniocerebral trauma and neurogenic heart disease can alleviate myocardial injury to a certain extent and effectively improve the short-term prognosis of patients.