摘要
目的 探究左侧星状神经节阻滞对心内直视术患者血流动力学及预后的影响。方法 选取111例心内直视术患者作为研究对象,依据随机数字分配法分为观察组(56例)和对照组(55例)。对照组患者给予局部麻醉(局麻)后采集右侧颈内的血液标本并实行心内直视术,观察组患者在对照组基础上实行左侧星状神经节阻滞术。比较两组患者在逆行置管后(T0)、主动脉开放10 min(T1)、术后2 h(T2)、术后6 h(T3)、术后24 h(T4)时的血流动力学指标、血浆炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)]水平及血浆神经组织蛋白(S100β)、神经元特异性烯醇化酶(NSE)水平。结果 两组患者T0~T4时平均动脉压(MAP)、心率(HR)无明显差异(P>0.05)。两组患者T0时血浆炎症因子水平无明显差异(P>0.05);两组患者T1~T4时TNF-α、IL-8、IL-10均高于T0时,且观察组患者T1~T4时TNF-α、IL-8、IL-10均优于对照组(P<0.05)。两组患者TNF-α、IL-8、IL-10在T1~T4时随着时间变化先升高后降低,以T2时水平达到最高。T0~T4时,观察组患者S100β分别为(0.33±0.10)、(1.26±0.25)、(1.02±0.04)、(0.67±0.15)、(0.43±0.11)μg/L, NSE分别为(7.68±0.59)、(10.09±0.78)、(9.41±0.62)、(9.10±0.66)、(8.01±0.51)μg/L;对照组患者S100β分别为(0.31±0.08)、(1.52±0.35)、(1.18±0.12)、(1.05±0.33)、(0.52±0.25)μg/L, NSE分别为(7.56±0.65)、(11.35±1.33)、(10.66±1.01)、(10.56±1.02)、(8.98±0.68)μg/L。相比于T0时,两组患者的S100β、NSE水平在T1~T4时均有所上升(P<0.05);相比于对照组,观察组患者的S100β及NSE水平在T1~T4时均降低(P<0.05)。结论 左侧星状神经节阻滞对心内直视术患者血流动力学影响较小,且可减轻患者体内的炎症反应,改善神经因子。
Objective To explore the effect of left stellate ganglion block on hemodynamics and prognosis in patients undergoing open heart surgery.Methods 111 patients who underwent open heart surgery were selected as the research subjects.According to the random number distribution method,they were divided into an observation group(56 cases)and a control group(55 cases).In the control group,the blood samples in the right neck of the patients were collected after local anesthesia,then underwent open heart surgery.The observation group underwent left stellate ganglion block based on the control group.Comparison was made on hemodynamic indicators,plasma inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-8(IL-8),interleukin-10(IL-10)],plasma levels of nerve tissue protein(S100β)and neuron specific enolase(NSE)after retrograde catheterization(T0),10 min after aortic opening(T1),2 h after surgery(T2),6 h after surgery(T3),and 24 after surgery between the two groups.Results There was no significant difference in mean arterial pressure(MAP)and heart rate(HR)between the two groups at T0-T4(P>0.05).There was no significant difference in plasma levels of inflammatory factors at T0 between the two groups(P>0.05).TNF-α,IL-8 and IL-10 at T1-T4 in both groups at T1-T4 were higher than those at T0,and TNF-α,IL-8 and IL-10 in the observation group were better than those in the control group at T1-T4(P<0.05).TNF-α,IL-8 and IL-10 in both groups increased first and then decreased with time at T1-T4,and reached the highest level at T2.At T0-T4,in the observation group,S100βwere(0.33±0.10),(1.26±0.25),(1.02±0.04),(0.67±0.15)and(0.43±0.11)μg/L,and NSE were(7.68±0.59),(10.09±0.78),(9.41±0.62),(9.10±0.66)and(8.01±0.51)μg/L;in the control group,S100βwere(0.31±0.08),(1.52±0.35),(1.18±0.12),(1.05±0.33)and(0.52±0.25)μg/L,and NSE were(7.56±0.65),(11.35±1.33),(10.66±1.01),(10.56±1.01)and(8.98±0.68)μg/L.Compared with T0,the levels of S100βand NSE increased at T1-T4 in both groups(P<0.05).Compared with the control group,S100βand NSE level of patients in the observation group were decreased at T1-T4(P<0.05).Conclusion Left stellate ganglion block has little effect on hemodynamics,but it can reduce the inflammatory reaction in patients,and improve nerve factors.
作者
徐明清
陈文
万震威
张伟平
廖成全
XU Ming-qing;CHEN Wen;WAN Zhen-wei(Anesthesiology Department,Shaoguan Yuebei People's Hospital,Shaoguan 512026,China)
出处
《中国实用医药》
2024年第21期48-51,共4页
China Practical Medicine
基金
2022年度韶关市卫生健康科研计划项目(项目编号:Y22018)。
