摘要
目的探讨星状神经节阻滞(SGB)对颈动脉内膜切除术患者术后恢复质量及血清炎症因子、神经元特异性烯醇化酶(NSE)的影响。方法选取92例南京医科大学附属苏州医院择期行颈内动脉切除术患者,不限性别,40岁≤年龄≤75岁,ASAⅡ~Ⅲ级。随机分成星状神经节阻滞组(SGB组,n=46)和对照组(n=46)。SGB组在颈内动脉切除术前接受了SGB处理,而对照组则没有进行SGB处理。分别在麻醉诱导插管后即刻、阻断前、血管开放后、术毕、术后6 h、术后24 h,ELISA检测血清中白细胞介素-1β(IL-1β)、IL-6、IL-10和NSE的浓度。记录两组围术期主要不良事件及血管活性药使用率。记录两组患者在手术前1 d、手术后3 d、手术后7 d的简易精神状态评价量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分以及恢复质量15项量表(QoR-15)评分。结果SGB组的血清IL-1β、IL-6浓度以及NSE水平明显低于对照组,而白IL-10浓度则显著高于对照组(P<0.05)。围术期SGB组患者高血压、恶心呕吐、低氧血症发生率及血管活性药物使用率均显著低于对照组(P<0.05)。SGB组手术后7 d的MMSE、MoCA评分以及QoR-15均高于对照组(P<0.05)。结论星状神经节阻滞能够有效减缓颈动脉内膜切除术患者围术期炎性反应,降低血清NSE水平,提高术后短期恢复质量,减少不良事件的发生。
Objective To investigate the effect of stellate ganglion block(SGB)on postoperative recovery quality,serum inflammatory factors,and neuron-specific enolase(NSE)in patients undergoing carotid endarterectomy.Methods A total of 92 male or female patients who underwent elective carotid endarterectomy in The Affiliated Suzhou Hospital of Nanjing Medical University were enrolled,with an age of 40–75 years and an ASA grade ofⅡ–Ⅲ.The patients were randomly divided into SGB group with 46 patients and control group with 46 patients.The patients in the SGB group received SGB treatment before carotid endarterectomy,while those in the control group did not undergo SGB.ELISA was used to measure the serum levels of interleukin-1β(IL-1β),interleukin-6(IL-6),interleukin-10(IL-10),and NSE immediately after anesthesia intubation,before blocking,after vessel opening,at the end of surgery,and at 6 and 24 hours after surgery.Major adverse cardiac events during the perioperative period and the rate of use of vasoactive agents were recorded for both groups,as well as Mini-Mental State Examination(MMSE)score,Montreal Cognitive Assessment(MoCA)score,and Quality of Recovery-15(QoR-15)score on day 1 before surgery and on days 3 and 7 after surgery.Results Compared with the control group,the SGB group had significantly lower serum levels of IL-1β,IL-6,and NSE and a significantly higher serum level of IL-10(P<0.05).During the perioperative period,compared with the control group,the SGB group had significantly lower incidence rates of hypertension,nausea and vomiting,and hypoxemia and a significantly rate of use of vasoactive agents(P<0.05).The SGB group had significantly higher MMSE,MoCA,and QoR-15 scores than the control group on day 7 after surgery(P<0.05).Conclusion For patients undergoing carotid endarterectomy,SGB can effectively alleviate perioperative inflammatory response,reduce the serum level of NSE,improve the quality of short-term postoperative recovery,and reduce adverse events.
作者
杨昌建
韩丽
赵月
袁晨
杨芬
沈军
谢阳
YANG Changjian;HAN Li;ZHAO Yue(Department of Anesthesiology,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215002,China)
出处
《中风与神经疾病杂志》
2025年第9期823-829,共7页
Journal of Apoplexy and Nervous Diseases
基金
江苏省自然科学基金项目(BE2017661)。
