摘要
目的 评价连续星状神经节阻滞预防颅内动脉瘤介入术后患者脑血管痉挛的效果.方法 择期拟行脑颅内动脉瘤介入术的动脉瘤破裂患者40例,性别不限,年龄20～ 60岁,ASA分级Ⅱ或Ⅲ级,颅内动脉瘤Hunt-Hess分级Ⅰ-Ⅲ级,采用随机数字表法分为2组（n=20）：对照组（C组）和连续星状神经节阻滞组（SGB组）.SGB组麻醉诱导后用20 G动脉套管针行患侧连续星状神经节阻滞,注射0.25％罗哌卡因6～8 ml,留置套管持续输注0.2％罗哌卡因2 ml/h,连续3d.术后3d内采用经颅多普勒超声测定仪双侧大脑中动脉和颈内动脉血流,评估脑血管痉挛的发生情况;分别于术前（T0）、术后2 h（T1）、6 h（T2）、1 d（T3）和3 d（T4）时采集颈内静脉血样,采用ELISA法测定血浆褪黑素（MT）及内皮素-1（ET-1）的浓度.结果 与C组比较,SGB组脑血管痉挛发生率（5％）降低,T1～4时血浆ET-1浓度降低（P＜0.05）,各时点血浆MT浓度差异无统计学意义（P＞0.05）.结论 连续星状神经节阻滞可有效预防颅内动脉瘤介入术后患者脑血管痉挛的发生,其机制可能与抑制血管内皮细胞释放ET-1有关,与MT无明显关系.
Objective To evaluate the efficacy of continuous stellate ganglion block （SGB） for prevention of cerebral vasospasm （CVS） following interventional treatment of intracranial aneurysms.Methods Forty patients of both sexes with ruptured intracranial aneurysm,aged 20-60 yr,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,with Hunt-Hess grade Ⅰ-Ⅲ,scheduled for elective interventional treatment of intracranial aneurysms,were divided into 2 groups （n =20 each） using a random number table：control group （C group） and continuous SGB group （SGB group）.After induction of anesthesia,patients received ipsilateral continuous SGB with 0.25% ropivacaine 6-8 ml followed by continuous infusion of 0.2% ropivacaine 2 ml/h for 3 days in group SGB.Transcranial Doppler ultrasound was used to measure the blood flow in bilateral middle cerebral arteries and internal carotid arteries within 3 days after operation,and the development of CVS was assessed.Before operation and at 2 and 6 h and 1 and 3 days after operation,blood samples were collected from the internal jugular vein for determination of plasma melatonin （MT） and endothelin-1 （ET-1） concentrations by enzyme-linked immunosorbent assay.Results Compared with group C,the incidence of CVS （5%） was significantly decreased,and the plasma ET-1 concentration was decreased at 2 and 6 h and 1 and 3 days after operation （P 〈 0.05）,and no significant change was found in plasma MT concentrations at each time point in group SGB （P〉0.05）.Conclusion Continuous SGB can effectively prevent the development of CVS following interventional treatment of intracranial aneurysms,and the mechanism may be related to inhibited release of ET-1 from vascular endothelial cells,but not related to MT.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2017年第1期43-46,共4页
Chinese Journal of Anesthesiology
