摘要
目的探讨超声引导下星状神经节阻滞对头面部手术患者呼吸、循环、免疫功能、炎症反应、镇痛效果及麻醉相关并发症的影响。方法选取行头面部手术的患者80例,随机分为对照组与观察组,每组40例。观察组在麻醉诱导前行超声引导下星状神经节阻滞,对照组麻醉诱导前不进行任何阻滞麻醉干预。比较2组患者围术期呼吸、循环、免疫功能及炎症指标变化情况,术后不同时点视觉模拟量表(VAS)评分,围术期麻醉相关并发症发生情况。结果2组患者术前1 d、麻醉诱导前、拔管时及术后1 h的呼吸频率组间及组内比较差异均无统计学意义(P>0.05)。2组患者术前1 d、麻醉诱导前的心率比较差异无统计学意义(P>0.05),拔管时及术后1 h的心率比较差异有统计学意义(P<0.05);观察组不同时点的心率组内比较差异无统计学意义(P>0.05),对照组不同时点的心率组内比较差异有统计学意义(P<0.05)。2组患者术前1 d的免疫球蛋白(Ig)G、IgA、IgM比较差异无统计学意义(P>0.05);2组患者术后3 d的IgG、IgA、IgM均低于术前1 d(P<0.05);对照组术后3 d的IgG、IgA、IgM低于观察组(P<0.05)。2组患者术前1 d血清肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)比较差异无统计学意义(P>0.05),2组患者术后3 d血清TNF-α及IL-6高于术前1 d(P<0.05),对照组术后3 d血清TNF-α及IL-6高于观察组(P<0.05)。术后24 h、48 h,观察组疼痛VAS评分低于对照组(P<0.05)。2组患者围术期麻醉相关并发症发生率比较差异无统计学意义(P>0.05)。结论头面部手术患者术前实施超声引导下星状神经节阻滞有助于维持术中循环稳定,减轻围术期免疫抑制及炎症反应,提高术后镇痛效果,对呼吸功能影响较小,且不会增加围术期麻醉相关并发症。
Objective To investigate the effect of ultrasound-guided stellate ganglion block on respiration,circulation,immune function,inflammatory response,analgesic effect and anesthesia-related complications in patients undergoing head and face surgery.Methods A total of 80 patients underwent head and face surgery were selected and randomly divided into the control group and the observation group,with 40 cases in each group.The observation group received ultrasound-guided stellate ganglion block before anesthesia induction,and the control group did not receive any block anesthesia intervention before anesthesia induction.The changes of respiration,circulation,immune function and inflammatory indexes during the perioperative period,the visual analogue scale(VAS)score at different time points after operation and the incidence of perioperative anesthesia-related complications of the two groups were compared.Results There was no statistically significant difference in the respiratory rate between and within the two groups 1 day before surgery,before anesthesia induction,at the time of extubation and 1 hour after surgery(P>0.05).There was no statistically significant difference in the heart rate between the two groups 1 day before surgery and before anesthesia induction(P>0.05),and there were statistically significant differences in the heart rate at the time of extubation and 1 hour after surgery(P<0.05).There was no statistically significant difference in the heart rate at different time points in the observation group(P>0.05),and there was statistically significant difference in the heart rate at different time points in the control group(P<0.05).There was no statistically significant difference in the immunoglobulin(Ig)G,IgA and IgM between the two groups 1 day before surgery(P>0.05);the IgG,IgA and IgM of the two groups 3 days after surgery were lower than those 1 day before operation(P<0.05),and the IgG,IgA and IgM of the control group were lower than those of the observation group 3 days after operation(P<0.05).There was no statistically significant difference in the serum tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)between the two groups 1 day before surgery(P>0.05),the serum TNF-αand IL-6 of the two groups 3 days after surgery were higher than those 1 day before surgery(P<0.05),and the serum TNF-αand IL-6 of the control group were higher than those of the observation group 3 days after operation(P<0.05).At 24 hours and 48 hours after surgery,the pain VAS score of the observation group was lower than that of the control group(P<0.05).There was no statistically significant difference in the incidence of perioperative anesthesia-related complications between the two groups(P>0.05).Conclusion For patients undergoing head and face surgery,the preoperative ultrasound-guided stellate ganglion block is helpful to maintain the intraoperative stability of circulation,alleviate perioperative immunosuppression and inflammatory response,improve the effect of postoperative analgesia,and it has little impact on respiratory function and will not increase the perioperative anesthesia-related complications.
作者
姜全威
薛志强
王跃
王东伟
JIANG Quan-wei;XUE Zhi-qiang;WANG Yue;WANG Dong-wei(Department of Anesthesiology,Benxi Central Hospital,Benxi Liaoning 117000,China;Department of Anesthesiology,First Affiliated Hospital of Jiamusi University,Jiamusi Heilongjiang 154000,China)
出处
《局解手术学杂志》
2021年第8期671-675,共5页
Journal of Regional Anatomy and Operative Surgery
关键词
超声引导
星状神经节阻滞
头面部
手术
呼吸
循环
免疫功能
炎症反应
ultrasound guidance
stellate ganglion block
head and face
surgery
respiration
circulation
immune function
inflammatory response
