国际麻醉学与复苏杂志   2018, Issue (12): 0-0
    
星状神经节阻滞对下肢手术止血带反应及气管插管反应的循环稳定性的影响
孟双双, 许铁, 武红会, 刘佩, 刘苏, 齐敦益, 刘金东, 刘功俭, 曹君利1()
1.徐州医科大学附属医院
Effects of stellate ganglion block on the circulation stability of lower extremity tourniquet and endotracheal intubation
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摘要:

目的 观察超声引导下星状神经节阻滞(stellate ganglion block, SGB)对骨科手术中下肢止血带反应的影响。 方法 择期静脉全身麻醉下行单侧下肢膝关节置换手术患者60例,ASA 分级Ⅰ、Ⅱ 级,年龄 18~75岁,采用随机数字表法将患者分为2组:对照组和SGB组,每组30例。全身麻醉前,对照组采用右侧三角肌注射1%利多卡因10 ml,SGB组于右颈部行SGB。观察麻醉诱导前(T0)、气管插管前(T1)、气管插管后1 min(T2)、止血带充气前(T3)、止血带充气30 min(T4)、止血带充气1 h(T5)、止血带放气前(T6)、止血带放气3 min(T7)、止血带放气30 min(T8)患者的HR、SBP变化,并记录麻醉深度及药物用量。 结果 SGB组30例患者神经阻滞全部成功。SGB组T2、T6时HR明显低于对照组,T2、T5~T7时SBP明显低于对照组(P<0.05);两组患者T0、T1、T3、T4、T8时HR、SBP差异无统计学意义(P>0.05)。两组患者一般资料及丙泊酚、瑞芬太尼、麻黄素、去氧肾上腺素用量差异无统计学意义(P>0.05),SGB组乌拉地尔用量低于对照组,差异有统计学意义(P<0.05)。 结论 SGB能够减轻止血带诱发心血管反应,维持患者循环稳定,降低气管插管反应。

关键词: 星状神经节阻滞; 止血带
Abstract:

Objective To examine the effect of ultrasound-guided stellate ganglion block (SGB) on the tourniquet reaction of the lower limbs. Methods A total of sixty patients undergoing unilateral knee replacement surgery under general anesthesia were divided into 2 groups (n=30): control group and group SGB. The age of patients was 18-75 years old with ASA gradeⅠ,Ⅱ. Before general anesthesia, 1% lidocaine (10 ml) was injected into the right deltoid muscle in control group, but in the right cervical stellate ganglion in group SGB. HR, SBP, BIS and drug doses were recorded at various time points: before induction of anesthesia (T0), before intubation (T1), 1 min after intubation (T2), before tourninquet inflated (T3), tourniquet inflatable 30 min (T4), tourniquet inflation 1 h (T5), tourniquet deflation(T6), tourniquet deflation 3 min (T7) and tourniquet deflation 30 min (T8) after discharge. Results Compared with control group, group SGB showed significantly lower SBP at T2, T5, T6 and T7 (P<0.05), while significantly smaller HR changes at T2 and T7 (P<0.05). There was no significant difference at T0, T3 and T8 between the two groups (P>0.05). There was no significant difference in the BIS, the doses of propofol, remifentanil, ephedrine and phenylephrine between the two groups, while the dose of urapidil in group SGB was significantly less than control group. Conclusions SGB can reduce the cardiovascular response to the tourniquet and maintain stable perioperative circulation.

Key words: Stellate ganglion block; Tourniquet