超声引导C7星状神经节阻滞对全麻围拔管期血流动力学的影响

目的:观察超声引导C7星状神经节阻滞对全麻患者围拔管期血流动力学的影响。方法:选择胸腹部择期手术患者(ASA分级Ⅰ或Ⅱ级)60例,随机分为A、B、C 3组,每组20例(随机数字表法)。术前选择气管插管全身麻醉,诱导方式为快诱导,术中机械通气。A、B组手术结束时分别给予左、右侧超声引导C7星状神经节阻滞后停麻药送PACU,C组手术结束后无操作再停麻药送PACU。术毕患者符合拔管指征时边吸痰边拔除气管插管。记录出手术室前(基础值,T0)、拔管时(T1)、拔管后5 min(T2)的收缩期动脉血压(SBP)、舒张期动脉血压(DBP)、心率(HR)。同时,对A、B两组行星状神经节阻滞后出现霍纳综合征的例数以及相关并发症(声音嘶哑、神经血管损伤等)的发生情况进行观察记录。结果:与A、B组相比,C组患者在T1、T2时点(较T0时点来看)的SBP、DBP明显增高,HR明显加快(P<0.05)。A、B组星状神经节阻滞后均出现霍纳综合征,暂未发现相关并发症。结论:超声引导C7星状神经节阻滞在胸腹部择期手术患者全麻拔管时可有效减轻拔管过程中的心血管反应,且超声引导C7入路星状神经节阻滞兼具了安全性和有效性(成功率高、并发症少)。

Effects of ultrasound-guided C7 stellate ganglion block on hemodynamics during periextubationof general anesthesia

Objective To observe the effects of ultrasound-guided C7 stellate ganglion block(SGB)on hemodynamics during periextubation of general anesthesia.Methods Sixty patients undergoing elective surgery of chest and abdomen(ASA gradeⅠ/Ⅱ)were selected and then divided into groupsA,B and C according to a random number table,with 20 patients per group.Preoperative intubation was rapidly induced by general anesthesia,and intraoperative mechanical ventilation was adopted during surgery.Before the patients were taken to postanesthesia care unit after the stop of anesthesia,the patients in groupsAand B were separately treated with left and right ultrasound-guided C7 SGB at the end of the surgery,while no postsurgery operation was carried out in group C.When the patients met the extubation indications,endotracheal intubation was removed with sputum aspiration.The systolic blood pressure,diastolic blood pressure and heart rate were recorded before leaving the operating room(the foundation value,T0),when the tracheal tube was removed(T1)and 5 min after extubation(T2).Meanwhile,the number of cases of appearing Horner's syndrome was recorded,and the occurrence of related complications such as hoarseness and neurovascular injury were observed in groupsAand B after SGB.Results Compared with those in groupsAand B,the systolic blood pressure and diastolic blood pressure in group C were significantly increased and heart rate was significantly accelerated at T1 and T2 as compared with T0(P<0.05).Horner's syndrome occurred in groups A and B after SGB,but no related complication was found.Conclusion Ultrasound-guided C7 SGB can effectively reduce cardiovascular response during extubation in patients undergoing elective surgery of chest and abdomen.Moreover,because of its high success rate and fewer complications,ultrasound-guided C7 SGB is considered safe and effective.