星状神经节阻滞术对全麻冠心病患者行肠癌手术血流动力学和心脏功能的影响

目的 探讨星状神经节阻滞术对冠心病患者行肠癌手术血流动力学和心脏功能的影响。方法 选择2014年6月—2017年3月于我院择期全麻下行腹腔镜肠癌手术合并冠心病患者54例,采用随机数字表法分为对照组、左侧星状神经节阻滞(L-SGB)组、右侧星状神经节阻滞(R-SGB)组,每组18例。比较3组患者在进入手术室(T₀)、全麻诱导后(T₁)、气管插管即时(T₂)、气管插管后5 min(T₃)的平均动脉压(MAP)、心率(HR)、心输出量(CO)、心脏指数(CI)、每搏输出量(SV)、每搏量变异度(SVV)及心率与收缩压乘积(RPP)等血流动力学指标变化,及在进入手术室(T₀)、麻醉后6 h(T₄)及24 h(T₅)的超氧化物歧化酶(SOD),丙二醛(MDA),一氧化氮(NO),心肌肌钙蛋白I(cTnI),肌酸激酶同工酶(CK-MB)等氧化应激指标及心肌酶的变化。结果 与T₀比较,T₁时3组患者的MAP、HR、CO、CI、SV及RPP均下降,但无统计学意义(P＞0.05);与T₀比较,T₂时3组患者的MAP、HR、CO、CI、SV及RPP均明显上升,有统计学意义(P＜0.05);与T₀比较,T₃时3组患者的MAP、HR、CO、CI、SV及RPP均有所下降,但R-SGB组比L-SGB组变化更明显且有统计学意义(P＜0.05);与L-SGB、R-SGB组比较,T₂时对照组MAP、HR、CO、CI、SV、SVV及RPP升高明显,有统计学意义(P＜0.05)。与T₀比较,T₄时3组患者的MDA、NO、cTnI、CK-MB显著上升,SOD显著下降,有统计学意义(P＜0.05);与对照组比较,T₄时R-SGB组和L-SGB组各指标变化幅度较小,有统计学意义(P＜0.05);与T₄比较,T₅时3组患者MDA、NO、cTnI、CK-MB有所下降,SOD有所上升,但对照组各指标与T₀比较时仍有统计学意义(P＜0.05),且R-SGB比L-SGB变化更为显著,但无统计学意义(P＞0.05)。结论 伴有冠心病的患者在全麻下行肠癌手术时,通过星状神经节阻滞可以增加患者血流动力学的稳定性,改善心脏功能,降低心肌的耗氧量,从而减轻手术应激对心肌细胞的损伤,且右侧星状神经节阻滞的效果比左侧阻滞效果更好。

Effects of stellate ganglion blocking on the hemodynamics and cardiac function in colon cancer patients with coronary heart disease undergoing surgery

Objective The objective of this study was to investigate effects of stellate ganglion blocking on the hemodynamics and cardiac function in patients with coronary heart disease(CHD).Methods A total of 54 colon cancer patients with CHD undergoing laparoscopic surgery underwent elective general anesthesia in our hospital from June 2014 to March 2017 were randomly divided into three groups(18 cases per group).They were the control,left stellate ganglion block(L-SGB),and right stellate ganglion block(R-SGB)groups.The patients′ mean arterial pressure(MAP),heart rate(HR),cardiac output(CO),cardiac index(CI),stroke output(SV),stroke,quantitative change thin(SVV)and heart rate and systolic blood pressure product(RPP),and other changes in hemodynamic parameters were compared in each group,after home invasion(T₀),induction of general anesthesia(T₁),the endotracheal tube into the glottis immediately(T₂),and 5 min after intubation(T₃).The changes of patients in superoxide dismutase(SOD),malondialdehyde(MDA),nitric oxide(NO)and cardiac troponin I(cTnI),creatine kinase isoenzyme(CK-MB)were also compared to T₀,6 h(T₄)and 24 h after anesthesia(T₅)in each group.Results Compared with T₀,the MAP,HR,CO,CI,SV and RPP of patients in each group were all decreased at T₁,but no statistical significance was found in these groups(P＞0.05).Compared with T₀,the MAP,HR,CO,CI,SV and RPP of patients in each group were significantly increased at T₂;there showed a statistical significance(P＜0.05).Compared with T₀,the MAP,HR,CO,CI,SV and RPP of patients in each group were decreased at T₃,but the decreased changes in the R-SGB group were more great than those in the L-SGB group(P＜0.05).Compared with L-SGB and R-SGB groups,the MAP,HR,CO,CI,SV,SVV and RPP were significantly increased at T₂ of patients in the control group(P＜0.05).Compared with T₀,the MDA,NO,cTnI and CK-MB in each group were significantly increased and significantly decreased in the SOD at T₄ of patients(P＜ 0.05).Compared with the control group,there had small changes in each index of patients in R-SGB and L-SGB groups at T₄,but there was a significant difference(P＜ 0.05).Compared with T₄,the levels of MDA,NO,cTnI and CK-MB were significantly decreased and the level of SOD were significantly increased at T₅ of patients in each group(P＜0.05),but all indexes in the control group compared with T₀ had statistical significance(P＜0.05).Although there had changes of R-SGB and L-SGB groups,they did not statistical significance(P＞0.05).Conclusion In patients with CHD during general anesthesia with colorectal cancer surgery,stellate ganglion blocking can increase hemodynamic stability,improve cardiac function,and reduce myocardial oxygen consumption,thereby reducing surgical stress damage to the cardiomyocytes.The right side of the stellate ganglion blocking has better effect than that in the left side block.