Pain and immune function in patients undergoing gastric cancer surgery following stellate ganglion block with total intravenous anesthesia

BACKGROUND Stellate ganglion block is a commonly used sympathetic nerve block technique that restores the balance of the sympathetic and vagal nervous systems of the body and inhibits sympathetic nerve activity.AIM To analyze the effect of a stellate ganglion block combined with total diploma intravenous anesthesia on postoperative pain and immune function in patients undergoing laparoscopic radical gastric cancer(GC)surgery to provide a refe-rence basis for the formulation of anesthesia protocols for radical GC surgery.METHODS This study included 112 patients who underwent laparoscopic radical surgery for GC between January 2022 and March 2024.There was no restriction on sex.The patient grouping method used was a digital random table method,and the num-ber of cases in each group was 56.The control group was administered total intravenous anesthesia,and the observation group compounded the stellate gan-glion block according to the total intravenous anesthesia protocol.Postoperative hemodynamics,pain levels,and immune indices were compared between the groups.RESULTS The heart rate and mean arterial pressure in the observation group after in-tubation were lower than those in the control group(P<0.05).Pain levels were compared between the two groups at 2 hours,12 hours,24 hours,and 48 hours after surgery(P>0.05).The number of CD3+,CD4+,and CD4+/CD8+cells at the end of surgery was higher in the observation group than in the control group,and the number of CD8+cells was lower in the observation group than in the control group(P<0.05).There were no significant differences between the two groups in terms of propofol dosage,awakening time,extubation time,or postoperative adverse reactions(P>0.05).CONCLUSION The application of a stellate ganglion block combined with total intravenous anesthesia had no significant effect on postoperative pain levels in patients undergoing laparoscopic radical GC surgery.However,it can safely reduce the effect of surgery on the immune function of patients and is worth applying in clinical practice.

Analysis of the Necessity of Stellate Ganglion Block after Anesthesia to Reduce the Risk of Cardiovascular Accidents in Coronary Heart Disease

Objective:To adjust the sympathetic nervous system through preoperative ultrasound-guided stellate ganglion block and to explore and analyze the situation and necessity of postanesthesia stellate ganglion block to reduce the risk of cardiovascular accidents in coronary heart disease.Methods:80 patients with cardiovascular risk factors in Songshan Hospital of Chifeng were selected,and the time span would cover from October 2022 to June 2024,with 80 cases of elective surgery and combined coronary heart disease.They will be randomly divided into blocked groups and conventional groups,40 cases each.Conventional block was performed after anesthesia in patients in the conventional group,and planetary ganglion block was performed after anesthesia in patients in the blocked group.The cardiovascular responses of patients in the two groups were observed,and the number of intraoperative cardiovascular active drugs and the occurrence of cardiovascular adverse events were recorded in patients in the two groups.Results:Analysis of the mean arterial pressure(MAP)and heart rate(HR)values of the two groups of patients at the time points before anesthesia(T0),the moment of tracheal intubation(T1),the moment of surgical skin cutting(T2),the end of the operation(T3),and the 6h postoperative period(T4)showed that the MAP and HR of the blocked group were lower than those of the conventional group at the time points of T1 to T4,and the differences in MAP and HR values of the two groups in different time points compared with the T0 time point were statistically significant(P<0.05)and the differences in cardiovascular response(P<0.05)were statistically significant(P<0.05).significance(P<0.05).The number of intraoperative cardiovascular active drugs used in the blocked group was shorter than that in the conventional group,and the incidence of cardiovascular adverse events was lower than that in the conventional group,with a statistically significant difference(P<0.05).Conclusion:By implementing preoperative ultrasound-guided stellate ganglion block in patients with cardiovascular risk factors,the frequency and degree of coronary heart disease symptoms will be reduced,thus reducing the risk of patients,which is worth promoting.

Efficacy and safety of stellate ganglion block in chronic ulcerative colitis

AIM To investigate the efficacy and safety of stellate ganglion block for the treatment of patients with chronic ulcerative colitis.METHODS A total of 120 randomly selected patients with chronic ulcerative colitis treated in Cangzhou Central Hospital from January 2014 to January 2016 were included in this study. These patients were divided into two groups: control group(n = 30), patients received oral sulfasalazine treatment; experimental group(n = 90), patients received stellate ganglion block treatment. Clinical symptoms and disease activity in these two groups were compared before and after treatment using endoscopy. Blood was collected from patients on day 0, 10, 20 and 30 after treatment. Enzyme-linked immunosorbent assay was performed to determine interleukin-8(IL-8) level. The changes in IL-8 level post-treatment in the two groups were compared using repeated measures analysis of variance.RESULTS After treatment, clinical symptoms and disease activity were shown to be alleviated by endoscopy in both the control and experimental groups. However, patients in the control group did not have obvious abdominal pain relief. In addition, the degree of pain relief in the experimental group was statistically better than that in the control group(P < 0.05). Ten days after treatment, IL-8 level was found to be significantly lower in the experimental group than in the control group, and the difference was statistically significant(P < 0.05). In addition, adverse events were significantly higher in the control group than in the experimental group, and the difference was statistically significant(χ~2 = 33.215, P = 0.000).CONCLUSION The application of stellate ganglion block effectively improves treatment efficacy in chronic ulcerative colitis, relieves clinical symptoms in patients, and reduces the level of inflammatory factors. Furthermore, this approach also had a positive impact on the disease to a certain extent.

Efficacy and safety of stellate ganglion block in chronic ulcerative colitis

Sympathetic system modulation by stellate ganglion blockade may modulate immune dysfunction and significantly improve symptoms of chronic ulcerative colitis.

Stellate ganglion block reduces inflammation and improves neurological function in diabetic rats during ischemic stroke

Diabetes mellitus is an independent risk factor for ischemic stroke.Both diabetes mellitus and stroke are linked to systemic inflammation that aggravates patient outcomes.Stellate ganglion block can effectively regulate the inflammatory response.Therefore,it is hypothesized that stellate ganglion block could be a potential therapy for ischemic stroke in diabetic subjects.In this study,we induced diabetes mellitus in rats by feeding them a high-fat diet for 4 successive weeks.The left middle cerebral artery was occluded to establish models of ischemic stroke in diabetic rats.Subsequently,we performed left stellate ganglion block with 1%lidocaine using the percutaneous posterior approach 15 minutes before reperfusion and again 20 and 44 hours after reperfusion.Our results showed that stellate ganglion block did not decrease the blood glucose level in diabetic rats with diabetes mellitus but did reduce the cerebral infarct volume and the cerebral water content.It also improved the recovery of neurological function,increased 28-day survival rate,inhibited Toll like receptor 4/nuclear factor kappa B signaling pathway and reduced inflammatory response in the plasma of rats.However,injection of Toll like receptor 4 agonist lipopolysaccharide 5 minutes before stellate ganglion block inhibited the effect of stellate ganglion block,whereas injection of Toll like receptor 4 inhibitor TAK242 had no such effect.We also found that stellate ganglion block performed at night had no positive effect on diabetic ischemic stroke.These findings suggest that stellate ganglion block is a potential therapy for diabetic ischemic stroke and that it may be mediated through the Toll like receptor 4/nuclear factor kappa B signaling pathway.We also found that the therapeutic effect of stellate ganglion block is affected by circadian rhythm.

Different Effects of Right and Left Stellate Ganglion Block on Systolic Blood Pressure and Heart Rate

Purpose: Whether or not right and left stellate ganglion blocks (SGB) affect blood pressure (BP) and heart rate (HR) differently has been controversial. The aim of this study was to analyze BP and HR changes after large numbers of right or left SGBs. Methods: A total of 16,404 right SGBs and 13,766 left SGBs were performed with 6 ml of 1% mepivacaine using the anterior paratracheal approach at C6. Changes in systolic BP and HR 30 min after SGBs were compared to the baseline values. Results: Systolic BP decreased by 25 to 49 mmHg in 10.93% and more than 50 mmHg in 0.67% of 16,404 right SGBs. Those percentages were significantly higher than corresponding percentages;8.43% and 0.49% of 13,766 left SGBs (P < 0.0001 and P < 0.05, respectively). On the other hand, systolic BP increased by 25-49 mmHg in 5.74% and more than 50 mmHg in 0.52% of left SGBs, and in 4.15% and 0.18% of right SGBs (P < 0.0001and P < 0.0001 between left and right SGBs, respectively). Right SGB caused marked reduction in HR (greater than 30 beats/min), more than left SGB (4.22% versus 2.70%, P Conclusions: Both right and left SGBs could produce clinically significant hypertension and hypotension, and also severe bradycardia. However, right SGB produces a higher incidence of significant reductions in systolic BP and HR, compared to left SGB. On the other hand, left SGB produces a significant increase in systolic BP compared to right SGB. Those differences likely stem from the hemispheric asymmetry in autonomic cardiovascular control.

Effect of sinomenine stellate ganglion block on chronic myocardial ischemia in rats

Objective:To investigate the protective effect of sinomenine stellate ganglion block(SGB)on chronic myocardial ischemia and its related mechanism.Methods:SD male and female rats(180~200g)were randomly divided into four groups:blank group,model group,lidocaine group,lidocaine+sinomenine group.The rats in blank group were fed with normal standard diet without modeling,and the other rats were fed with high-fat diet.After 8 weeks of feeding,the rats in high-fat diet group were significantly different from those in blank control group.Then they were randomly divided into 3 groups,10 rats in model group were injected with 0.9%NaCl into right stellate ganglion(RSG)After 2 weeks of continuous injection,pituitrin injection was continuously injected into sublingual vein of rats for 3 days,once every 24 hours;lidocaine group rats were injected with 0.24 mL 1%lidocaine injection in RSG,the rest was the same as model group;lidocaine+sinomenine group rats were injected with 0.24 mL 1%lidocaine injection+0.095 mL sinomenine hydrochloride+2.9 mL 0.8 mL 0.8 mL in RSG,the rest was the same as model group.At the end of the eighth week of the experiment,the rats in the high-fat diet feeding group and the standard ordinary diet feeding group were given the medicine after there was significant difference in blood lipid;before the third injection of pituitrin,the ECG changes of the rats in each group were observed;the general situation of the rats before and after the administration was observed;after the experiment,the blood of the rats in each group was taken from the abdominal aorta,and the serum oxidative stress indexes,such as total superoxide dismutase(SOD)and malondialdehyde,were detected(MDA,IL-6 and cTnI were measured.Results:compared with the blank group,the ECG of the model group changed significantly(P<0.01),the cTnI value increased significantly(P<0.01),indicating that the rat myocardial ischemia model was successfully established;compared with the model group,the SOD level of lidocaine group and lidocaine+sinomenine group increased significantly(P<0.05,P<0.01),the MDA level decreased significantly(P<0.05,P<0.01),IL-6 decreased significantly(P<0.05,P<0.01)05,P<0.01).Conclusion:sinomenine SGB has protective effect on rats with chronic myocardial ischemia,which is related to anti oxidative stress and inhibition of inflammatory reaction.

a Clinical Observation of Stellate Ganglion Block Used for Migraine

To observe the therapeutic effect of different drugs used in stellate ganglion block (SGB) on migraine, 80 patients suffering from migraine were randomly allocated into two groups. In group A STB were treated with mixture of lidocaine, vitamine B complex and txiamcinolone acetonide, while in group B nimodipine was also added. The analgestic duration and effect were measured by double－blinded. The analgestic duration in groupB was significantly longer than in group A and the complete pain－relieving percentage was significantly high (P<0.05) in group B.

Ultrasound-Guided Left Stellate Ganglion Blocks for Recurrent Ventricular Tachycardia (Electrical Storm)

Recurrent Ventricular Tachycardia, or Electrical Storm, is a relatively common cause of mortality and morbidity after myocardial infarction. We present a case in which left stellate ganglion blocks were performed under ultrasound guidance in order to alleviate recurrent ventricular tachycardia in a patient requiring extracorpeal membrane oxygenation after myocardial infarction. A medically complex 54-year-old male after two weeks removed from an acute ST elevation myocardial infarction status post stenting and intra-aortic balloon pump placement presented in the cardiovascular intensive care unit with recurrent unstable ventricular tachycardia while on extracorporeal membrane oxygenation and multiple vasoactive infusions. Our acute pain service was consulted by the cardiac electrophysiology service to provide left stellate ganglion blocks in attempt to attenuate electrical storm. Multiple single shot left stellate ganglion blocks were performed on subsequent days with increasing local anesthetic concentrations and volumes successfully providing temporary relief of electrical storm. A left stellate ganglion catheter was eventually placed, and a continuous infusion of local anesthesia was started. The patient experienced complete relief from unstable ventricular tachycardia and no further defibrillations were required. The catheter remained in place for 14 days allowing for extracorporeal membrane oxygenation decannulation without the return of electrical storm. We believe ultrasound guided left stellate ganglion blocks to be a relatively safe means to provide temporary relief of recurrent ventricular tachycardia.

Age and Gender-Related Differences in Hypotensive and Hypertensive Responses to Stellate Ganglion Block

Purpose: The aim of the current study was to investigate: 1) Whether there is an association between age and changes in systolic blood pressure (SBP) after stellate ganglion block (SGB), and 2) Whether gender plays a role in hypotensive and hypertensive responses to SGB. Methods: We retrospectively reviewed SBP changes (ΔSBP) due to SGB, which were performed on 1641 subjects. SBP 30 min after SGB was compared to the baseline values. For the age study, average age of both sexes was calculated for six ranges of ΔSBP. For the gender study, the numbers of subjects (%) in various ranges of positive and negative values of ΔSBP were compared between men and women. Results: There was a significant association between age and both increasing (p Conclusions: There was an association between age and blood pressure changes after SGB and the association is most likely due to age-related alteration of cardiovascular functions. The different changes of SBP between men and women after SGB may well be attributable to gender differences of autonomic nervous regulation;sympathetic dominant man versus, parasympathetic dominant women.

低温等离子射频消融术联合SGB治疗伴交感神经症状颈椎病的疗效评价

目的:评价CT引导下低温等离子射频消融术联合超声引导下星状神经节阻滞(stellate ganglion block,SGB)治疗伴交感神经症状颈椎病的临床疗效和安全性。方法:回顾性分析伴交感神经症状颈椎病病人73例临床资料,其中单纯行低温等离子射频消融术病人(A组)42例,行低温等离子射频消融术联合SGB病人(B组)31例。比较2组病人的一般资料、视觉模拟评分(visual analogue scale,VAS)、日本骨科协会评分(Japanese Orthopaedic Association scores,JOA)、交感神经症状评分、临床疗效以及并发症发生情况。结果:2组病人治疗前的VAS评分、JOA评分和交感神经症状评分差异无统计学意义(P>0.05);B组治疗后1、4周的VAS评分和治疗后1、4、12周的交感神经症状评分均低于A组(P<0.05~P<0.01),治疗后1、4周的JOA评分均高于A组(P<0.05和P<0.01)。治疗后12周,A组治疗总优良率为85.71%(36/42),与B组的87.10%(27/31)差异无统计学意义(P>0.05)。2组均无明显并发症发生。结论:低温等离子射频消融术联合SGB治疗伴交感神经症状颈椎病,有助于改善病人症状,促进病人康复,具有一定临床价值。

帕瑞昔布钠预给药+SGB复合全身麻醉对老年骨科患者术后早期认知功能及炎症因子水平的影响

目的评价帕瑞昔布钠预给药+星状神经节阻滞(stellate ganglion block,SGB)复合全身麻醉对老年骨科患者术后早期认知功能和炎症因子水平的影响。方法择期行关节置换术患者100例,年龄65~76岁,性别不限,体质量指数(body mass index,BMI)14.8~24.0kg/m2,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅱ级,采用随机数字表法分为两组,即对照组(n=50)和观察组(n=50),对照组麻醉诱导前30min静脉注射帕瑞昔布钠40mg,观察组诱导前30min静脉注射帕瑞昔布钠40mg和诱导前15min超声引导下给予右侧SGB。分别于给药前(T_(0))、气管插管后即刻(T_(1))、切皮即刻(T_(2))、切皮后1h(T_(3))、术后4h(T_(4))和术后24h(T_(5))时点抽取颈内静脉血样,采用ELISA法检测血清白细胞介素-6(interleukin-6,IL-6)IL-6、肿瘤坏死因子-α(tumor necrosis factorα,TNF-α)水平。采用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评分表评估认知功能,统计术后7d患者术后认知功能障碍(postoperative cognitive dysfunction,POCD)的发生率。结果与对照组比较,观察组T_(1~5)时点血清IL-6、TNF-α浓度降低(P<0.05),MoCA评分均高于对照组(P<0.05),POCD发生率下降(P<0.05)。结论帕瑞昔布钠预给药+SGB复合全身麻醉在老年骨科患者的应用,提高了该类患者术后认知功能评分,降低早期POCD的发生率,值得在临床上推荐使用。

星状神经节阻滞用于慢性主观性耳鸣困扰的辅助干预效果及预测指标初析

【目的】探讨星状神经节阻滞(SGB)用于慢性主观性耳鸣困扰的辅助干预效果,及相应的预测指标,为SGB应用于耳鸣的临床干预累积经验。【方法】回顾因其他干预方案效果不理想而在中山大学附属第三医院耳鼻咽喉-头颈外科接受SGB干预的慢性主观性耳鸣患者资料。SGB干预前进行耳鸣残疾量表(THI)评估、纯音听阈测试、耳鸣响度评估,部分患者接受了睡眠质量(PSQI)评估。SGB干预后复测THI,以评价SGB的干预效果。随后,通过相关分析及线性回归方程探寻预测SGB干预效果的潜在指标。数据的统计分析采用SPSS 24.0进行,P<0.05表示存在统计学意义。【结果】至2023年04月,共有107名慢性主观性耳鸣患者接受了SGB干预,其中男性患者67名,女性患者40名,平均(45.32±11.40)周岁,耳鸣持续(20.32±24.64)月[16(12~20)]。有7名患者因个人原因中途退组,退组率6.54%,干预依从性良好。所有患者均未出现穿刺部位感染、血肿、神经损伤、局麻药中毒等不良反应,安全性良好。SGB干预后,有77名患者的THI得分下降至36分及以下,剩余的患者中有12名的THI得分下降幅度达到10分及以上,有效率为89%;配对样本t检验显示,SGB干预前后的THI得分有显著的统计学差异(t=15.575,P<0.001),干预效果良好。皮尔逊相关分析显示,干预前的THI得分和耳鸣主观响度与THI的改善水平呈显著的正相关关系(P<0.05);进一步的逐步线性回归分析发现,“干预前THI得分”具有显著的统计学意义(P<0.001),回归系数为0.308,预测了THI改善水平的17.4%。【结论】SGB干预慢性主观性耳鸣困扰的短期效果良好、安全性高,可用于常规干预方案不理想时(尤其是THI得分较高患者)的补充方案,但后续研究需要明确长期疗效及内在机制,为SGB应用于主观性耳鸣的干预奠定更为扎实的理论基础。

电针舌三针辅助星状神经节阻滞对脑梗死后吞咽障碍患者吞咽功能的影响

目的探讨电针舌三针辅助星状神经节阻滞(Stellate ganglion block,SGB)对脑梗死后吞咽障碍患者吞咽功能的影响。方法选取2022年1月—2023年1月期间河北北方学院附属第二医院收治的90例脑梗死后吞咽障碍患者,依据简单随机数字表法分为对照组和研究组,每组各45例。对照组采取SGB治疗,研究组在对照组基础上采取电针舌三针疗法,共治疗14 d。统计两组患者治疗前后舌骨移动度、吞咽用时、吞咽功能(Standardized swallowing assessment,SSA)及生活质量(Swallowing Quality-of-Life Instrument,SWAL-QOL)评分、营养状态指标[白蛋白(Prealbumin,PA)、转铁蛋白(Transferrin,TRF)、白蛋白(Albumin,ALB)]平及不良事件发生情况。结果治疗后两组患者舌骨上、下移动度较治疗前增大,差异有统计学意义(P<0.05);且研究组优于对照组,差异有统计学意义(P<0.05)。治疗后两组患者喉关闭用时、咽运送用时、口腔运送用时、吞咽反应用时较治疗前缩短,差异有统计学意义(P<0.05);且研究组优于对照组,差异有统计学意义(P<0.05)。治疗后两组患者SSA评分较治疗前降低、SWAL-QOL评分较治疗前升高,差异有统计学意义(P<0.05);且研究组SSA评分低于对照组,SWAL-QOL评分高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者PA、ALB、TRF水平较治疗前升高,差异有统计学意义(P<0.05);且研究组高于对照组,差异有统计学意义(P<0.05)。治疗期间,研究组不良事件发生率4.44%(2/45)明显低于对照组17.78%(8/45),差异有统计学意义(P<0.05)。结论采取电针舌三针辅助SGB治疗脑梗死后吞咽障碍可增大舌骨移动度,缩短吞咽用时,利于改善吞咽功能及营养状态,提升生活质量,并降低不良事件发生风险。

星状神经节阻滞对大鼠炎症反应的作用及其机制研究

目的:观察星状神经节阻滞(SGB)对急性腹膜炎大鼠血清炎症因子的影响和α7nAChR蛋白表达情况,旨在深入探讨SGB对大鼠急性腹膜炎炎症反应的作用机制。方法:40只SPF级雄性大鼠随机分为4组:对照组(Control)、急性腹膜炎组(AP)、急性腹膜炎+星状神经节阻滞组(AP+SGB)、急性腹膜炎+星状神经节阻滞+α7nAChR抑制剂甲基牛扁亭碱组(AP+SGB+MLA),每组10只。将2%乙酸1 ml/100 g分别注入AP组、AP+SGB组和AP+SGB+MLA组大鼠腹腔内建立急性腹膜炎模型。ELISA法检测血清中IL-18和TNF-α的浓度。Western Blot法检测腹膜组织中α7nAChR蛋白水平,RT-qPCR法检测腹膜组织中α7nAChR mRNA的表达情况。结果:与Control组对比,其余3组血清IL-18和TNF-α水平增高(P<0.05);与AP组对比,AP+SGB组血清IL-18和TNF-α水平降低(P<0.05);与AP+SGB组对比,AP+SGB+MLA组血清IL-18和TNF-α水平增高(P<0.05)。腹膜组织α7nAChR蛋白和α7nAChR mRNA表达水平的比较:与Control组对比,其余3组α7nAChR蛋白和α7nAChR mRNA表达水平均增高(P<0.05);与AP组对比,AP+SGB组α7nAChR蛋白和α7nAChR mRNA表达水平增高(P<0.05);与AP+SGB组相比,AP+SGB+MLA组α7nAChR蛋白和α7nAChR mRNA表达水平降低(P<0.05)。结论:星状神经节阻滞治疗可以减少大鼠炎症因子的产生,抑制急性腹膜炎的炎症反应,其抗炎机制可能与α7nAChR介导的胆碱能抗炎通路(CAP)有关。

星状神经节阻滞联合YS1001P治疗仪治疗急性脑梗死伴吞咽困难临床观察

目的探讨星状神经节阻滞联合YS1001P治疗仪治疗急性脑梗死伴吞咽困难的临床效果。方法选取河北北方学院附属第二医院急性脑梗死伴吞咽困难患者80例,按照随机数字表法分为2组,每组40例。2组均行卒中后对症治疗,包含控制血压和血糖、抗血小板聚集、调节脂代谢、改善脑循环、营养脑神经以及并发症的防治等,在此基础上采用吞咽和神经肌电刺激仪YS1001P治疗,研究组额外行星状神经节阻滞治疗,20 d后采用洼田饮水试验评价患者临床疗效。采用藤岛一郎吞咽障碍评分和电视X线透视下吞咽造影检查(videofluroscopic swallowing study,VFSS)比较治疗前和治疗后2组的吞咽功能,比较对照组和研究组治疗前后血清神经生长因子(nerve growth factor,NGF)和脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)含量变化情况。结果治疗后,研究组藤岛一郎吞咽障碍评分高于对照组(P<0.05),口腔期、咽期、误吸评分及VFSS评分总分高于对照组(P<0.05),洼田饮水试验分级优于对照组(P<0.05),研究组治疗总有效率95.00%高于对照组77.50%(P<0.05),研究组血清NGF和BDNF含量高于对照组(P<0.05)。结论星状神经节阻滞联合YS1001P治疗仪治疗急性脑梗死伴吞咽困难的临床效果较好,患者吞咽功能改善明显,其作用机制可能与提高神经营养水平有关。

星状神经节阻滞对肩关节镜手术沙滩椅位脑血流动力学改变的影响研究

目的研究星状神经节阻滞对肩关节镜手术沙滩椅位脑血流动力学改变的影响。方法取择期行沙滩椅位肩关节镜手术患者40例,随机分为治疗组T组和对照组C组各20例,T组术前行超声引导下SGB,对比两组患者术中生命体征、BIS值、脑氧合饱和度(rSO_(2))、不同时段大脑中动脉血流频谱图像、术后7 d ULCA评分、MMSE评分、RBANS总分,将两组数据进行统计学处理分析。结果T组比C组患者术中生命体征变化波动较小,差异有统计学意义(P<0.05)。不同时段rSO_(2)基本保持在相同水平,差异无统计学意义(P>0.05);T组患者大脑中动脉血流流速比C组要低,但血管内径要大,根据公式得出T组患者在不同时间段血流量都要比C组同时段的多,比较差异有统计学意义(P<0.05)。两组术后7 d ULCA评分、MMSE评分、RBANS总分对比T组明显较高,差异有统计学意义(P<0.05)。结论对沙滩椅位行肩关节镜手术的患者术前实施星状神经阻滞术具有增加脑血供及脑保护作用且对患者术后关节功能恢复有良好的促进作用,有临床推广实用价值。

右侧星状神经节阻滞对腹腔镜胆囊切除术后肩痛的影响

目的探讨右侧星状神经节阻滞(SGB)对腹腔镜胆囊切除术(LC)患者术后肩痛的影响。方法选择2022年4—8月行LC患者104例,男32例,女72例,年龄18~64岁,ASAⅠ或Ⅱ级。将患者随机分为两组:SGB组(S组,n=51)和对照组(C组,n=53)。气管插管后即刻,S组使用0.2%罗哌卡因4 ml进行超声引导下的右侧SGB;C组在相同部位注射生理盐水4 ml。记录术后48 h内腹腔镜术后肩痛(PLSP)例数和PLSP持续时间;记录术毕即刻(T_(1))、术后2 h(T_(2))、6 h(T_(3))、12 h(T_(4))、24 h(T_(5))、48 h(T_(6))PLSP的VAS疼痛评分,评估PLSP程度;记录PCIA泵有效按压次数、补救镇痛例数;记录恶心、呕吐、腹胀等不良反应的发生情况。结果S组PLSP发生率、PLSP持续时间>10 h比例明显低于C组(P<0.05)。T_(3)—T_(5)时S组PLSP程度明显轻于C组(P<0.05)。S组PCIA泵有效按压次数明显少于C组,补救镇痛率明显低于C组(P<0.05)。S组恶心发生率明显低于C组(P<0.05)。结论右侧星状神经节阻滞可以降低LC患者PLSP发生率,缓解PLSP疼痛程度,降低不良反应发生率。

干预星状神经节治疗颈性眩晕的研究进展

颈性眩晕与严重的颈椎退行性变有关,近年来颈椎病在年轻人中的发病率呈上升趋势,颈椎病合并眩晕的老年患者日益增多。临床及实验研究证实通过刺激星状神经节(Stellate Ganglion,SG)治疗颈性眩晕具有见效快、疼痛轻、选穴少等特点。本文整理相关文献,对干预星状神经节治疗颈性眩晕的不同治疗方法进行归纳总结,提示星状神经节对颈性眩晕疗效显著。最后总结现有研究中亟待解决的问题,针对当前研究的不足提出了新的方向和建议。

术前超声引导下星状神经节阻滞对胸腔镜手术患者的肺保护作用及机制

目的探讨术前超声引导下星状神经节阻滞(SGB)对胸腔镜手术单肺通气(OLV)患者的肺保护作用及机制。方法选择2021年1月至2022年4月于南京医科大学附属苏州医院行胸腔镜下OLV肺叶切除术的84例患者为研究对象,按照随机数字表法将患者分为观察组和对照组,每组42例。观察组患者麻醉诱导前实施超声引导下SGB;对照组患者不做穿刺操作。2组患者采用相同的麻醉诱导和维持方案。记录患者入手术室后(T_(0))、OLV开始前(T_(1))、OLV开始后30 min(T_(2))、OLV开始后60 min(T_(3))、术毕(T_(4))、拔管后30 min(T_(5))时血流动力学、呼吸力学参数和动脉血气指标。比较各时间点2组患者氧合指数(OI)和肺内分流率(Qs/Qt)以及pH值。分别于T_(0)、T_(3)、T_(5)时,抽取2组患者静脉血,应用酶联免疫吸附法检测血清中肺表面活性物质相关蛋白-A(SP-A)、超氧化物歧化酶(SOD)、丙二醛(MDA)、白细胞介素(IL)-6及IL-10水平,记录患者术后SGB相关并发症及术后72 h内肺部并发症发生情况。结果2组患者T_(1)、T_(2)、T_(3)时的平均动脉压(MAP)和心率(HR)显著低于T_(0)时(P<0.05);T_(4)和T_(5)时的MAP和HR与T_(0)时比较差异无统计学意义(P>0.05),2组患者其他时间点间的MAP和HR比较差异无统计学意义(P>0.05)。T_(1)、T_(2)、T_(3)时,观察组患者的MAP显著低于对照组(P<0.05);T_(2)、T_(3)时,观察组患者的HR显著低于对照组(P<0.05);其他时间点,2组患者的MAP和HR比较差异无统计学意义(P>0.05)。T_(0)~T_(5)各时间点2组患者的脉搏氧饱和度(SpO_(2))比较差异无统计学意义(P>0.05)。2组患者T_(2)、T_(3)时的气道峰压(Ppeak)、呼吸频率(RR)显著高于T_(1)和T_(4)时,潮气量(TV)显著低于T_(1)和T_(4)时(P<0.05);T_(2)、T_(3)时,观察组患者的Ppeak、TV显著低于对照组(P<0.05);T_(1)、T_(4)时,2组患者的Ppeak、TV比较差异无统计学意义(P>0.05);T_(1)~T_(4)时,2组患者的RR、呼气末二氧化碳分压(PetCO_(2))比较差异无统计学意义(P>0.05)。T_(0)~T_(5)时,2组患者的pH比较差异无统计学意义(P>0.05)。2组患者T_(1)与T_(0)时的OI比较差异无统计学意义(P>0.05);2组患者T_(2)~T_(5)的OI显著低于T_(0)和T_(1)时(P<0.05);T_(2)~T_(5)时,观察组患者的OI值显著高于对照组(P<0.05)。2组患者T_(2)~T_(5)时的Qs/Qt值显著高于T_(0)、T_(1)时(P<0.05);T_(2)~T_(5)时,观察组患者的Qs/Qt显著低于对照组(P<0.05)。2组患者T_(3)和T_(5)时的血清SP-A、IL-6水平显著高于T_(0)时(P<0.05);T_(3)、T_(5)时,观察组患者的SP-A、IL-6水平显著低于对照组(P<0.05)。对照组患者T_(3)和T_(5)时血清IL-10水平低于T_(0)时,观察组患者T_(3)和T_(5)时的血清IL-10水平高于T_(0)时(P<0.05);T_(3)、T_(5)时,观察组患者的血清IL-10水平显著高于对照组(P<0.05)。对照组患者T_(3)和T_(5)时血清MDA水平显著高于T_(0)时(P<0.05);观察组患者T_(3)和T_(5)时血清MDA水平与T_(0)时比较差异无统计学意义(P>0.05);T_(3)、T_(5)时,观察组患者血清MDA水平显著低于对照组(P<0.05)。T_(3)、T_(5)时,对照组患者血清SOD水平显著低于T_(0)时,观察组患者血清SOD水平显著高于T_(0)时(P<0.05);T_(3)、T_(5)时,观察组患者血清SOD水平显著高于对照组(P<0.05)。观察组患者中4例出现单侧喉返神经阻滞症状,1例患者出现臂丛神经阻滞,均于术后24 h内好转,术后随访未见其他不良反应。术后72 h内对照组有1例患者出现低氧血症。结论术前超声引导下SGB可以显著改善胸腔镜手术OLV患者的OI,减少肺内分流,抑制炎症反应和氧化应激,从而发挥肺保护作用。