超声引导下右侧星状神经节阻滞对腹腔镜胃癌根治术患者双侧脑血流的影响

目的观察超声引导下右侧星状神经节阻滞(stellate ganglion block, SGB)对腹腔镜下胃癌根治术患者双侧脑血流的影响。方法选择2017年8月至2019年2月择期行腹腔镜下胃癌根治术患者60例,男31例,女29例,年龄60~80岁,ASAⅡ或Ⅲ级,采用随机数字表法将患者随机分为两组,每组30例:SGB组(S组)和对照组(C组)。S组于麻醉诱导前在超声引导下行右侧SGB,注入0.375%罗哌卡因8 ml,C组注射等容量生理盐水。通过经颅多普勒超声(TCD)记录SGB前(T0)、SGB后5 min(T1)、30 min(T2)、60 min(T3)、手术结束(T4)时双侧大脑中动脉(MCA)平均血流速度(Vm),计算搏动指数(PI)和阻抗指数(RI),同时记录T0-T4时的MAP、HR和CVP。结果与T0时比较,T2-T4时C组双侧Vm、MAP明显降低,双侧PI和RI明显升高(P<0.05);T2-T4时S组双侧Vm明显明显降低(P<0.05),非阻滞侧PI和RI明显升高(P<0.05);T2时S组MAP明显降低(P<0.05)。T3、T4时C组MAP明显低于S组(P<0.05)。结论超声引导右侧星状神经节阻滞可以明显降低阻滞侧颅内动脉血管阻力,增加腹腔镜下胃癌根治术中颅内血流动力学的稳定性。

Effect of ultrasound-guided right stellate ganglion block on bilateral cerebral blood flow undergoing laparoscopic radical gastrectomy

Objective To investigate the effect of ultrasound-guided right stellate ganglion block(SGB) on bilateral cerebral blood flow undergoing laparoscopic radical gastrectomy by transcranial doppler(TCD). Methods Sixty patients who underwent laparoscopic radical gastrectomy under general anesthesia from August 2017 to February 2019, 31 males and 29 females, aged 60-80 years, falling into ASA physical status Ⅱ or Ⅲ, were randomly divided into 2 groups(n = 30 in each group) by using random number table method: group S and group C. The patients in group S were treated with ultrasound-guided right stellate ganglion block before induction with 0.375% ropivacaine 8 ml, and the patients in group C were treated with equal volume of saline. Mean blood flow velocity(Vm) of bilateral middle cerebral artery were recorded and pulsatility index(PI) and resistance index(RI) were calculated before SGB(T0), 5 min after SGB(T1), 30 min after SGB(T2), 60 min after SGB(T3) and at the end of surgery(T4) by TCD. MAP, HR and CVP were recorded at the same time points. Results Compared with T0, the bilateral Vm and MAP were significantly lower, the bilateral PI and RI were significantly higher in group C at T2-T4(P < 0.05). Compared with T0, the bilateral Vm were significantly lower, PI and RI of the non-blocked side were significantly higher in group S at T2-T4(P < 0.05). Compared with T0, the MAP was significantly lower in group S at T2(P < 0.05). The MAP in group C was lower than those in group S at T3 and T4(P < 0.05). Conclusion Ultrasound-guided right stellate ganglion block can significantly alleviate the high resistance of intracranial arteries of blocked side and increase the stability of intracranial hemodynamics during laparoscopic surgery.