赵月,
韩丽,
赵李红,
杨芬,
谢阳^,
南京医科大学 姑苏学院 南京医科大学附属苏州医院 苏州市立医院 麻醉科，江苏 苏州 215002

详细信息 作者简介: 赵 月（1999-），女，住院医师。E-mail：zhaoydoctor@163.com





通讯作者: 谢 阳，副教授。E-mail：xieyangeagle@163.com 中图分类号: R735.3；R619


摘要:目的 探讨超声引导下星状神经节阻滞（stellate ganglion block，SGB）在单肺通气（one-lung ventilation，OLV）患者肺保护中的潜在作用。方法 将择期行单肺通气手术患者123例随机分为三组：观察组（S组）、对照组（C组）和空白组（B组），每组41例。S组麻醉诱导前实施超声引导下SGB；C组将局麻药替换为相同体积生理盐水；B组不做穿刺操作。三组采用相同的麻醉诱导和维持方案。记录入室后（T0）、OLV开始前（T1）、OLV开始后30 min（T2）、OLV开始后60 min（T3）、术毕（T4）、拔管后30 min（T5）时血流动力学、呼吸力学参数和动脉血气分析。比较各时间点氧合指数（OI）和肺内分流率（Qs/Qt）以及pH值。分别在T0、T3、T5取静脉血清检测肺表面活性物质相关蛋白-A（SP-A）、超氧化酶歧化酶（SOD）、丙二醛（MDA）、白介素-6（IL-6）以及白介素-10（IL-10）。记录术后SGB相关并发症及术后72小时内肺部并发症发生情况。结果 T1、T2、T3时S组MAP低于B组、C组（P＜0.05）；T2、T3时S组HR低于B组、C组（P＜0.05）。T2、T3时S组气道峰压（P_peak）、潮气量（VT）低于B组、C组（P＜0.05）；T1～T4组间RR、呼末二氧化碳（EtCO₂）比较，差异无统计学意义（P＞0.05）。T2～T5时S组OI高于B组、C组（P＜0.05），而Qs/Qt低于B组、C组（P＜0.05）。T3和T5时S组SP-A、IL-6、MDA低于B、C组（P＜0.05），而IL-10、SOD高于B、C组（P＜0.05）。C组和S组各有3例和4例出现穿刺后局部血肿和单侧喉返神经阻滞症状（P＞0.05），上述患者均未予特殊处理，于术后24小时内好转。术后72小时内B组有1例出现低氧血症。结论 超声引导下SGB对单肺通气患者具有肺保护作用，可以显著改善单肺通气患者的OI，减少肺内分流，减少呼吸机相关肺损伤，抑制炎症反应和氧化应激。
关键词: 星状神经节阻滞/
单肺通气/
肺保护/
炎症反应/
氧化应激


Abstract:ObjectiveTo study the potential effect of ultrasound-guided stellate ganglion block (SGB) on lung protection for patients undergoing one-lung ventilation (OLV).MethodsA total of 123 patients undergoing elective one-lung ventilation surgery were randomly divided into SGB group, control group and blank group with 41 patients in each group. Stellate ganglion block was carried out in SGB and control groups. Patients in SGB group were injected with 6ml mixture of 0.25% ropivacaine hydrochloride and 1% lidocaine hydrochloride, while those in control group were injected with 6 mL of 0.9% saline. Punctures weren't performed for patients in blank group. The same induction and maintenance of general anesthesia was adopted for three groups. Hemodynamics, respiratory parameters and arterial blood gas analysis were recorded after entering the operation room (T0), pre-OLV (T1), 30 min after OLV (T2), 60 min after OLV (T3), at the end of surgery (T4), and 30 min after extubation (T5). Oxygenation index (OI), pulmonary shunt fraction (Qs/Qt) and pH value were compared at different time points. Intravenous serum was collected at T0, T3 and T5 for the measurement of surfactant proteins A (SP-A), superoxide dismutase (SOD), malondialdehyde (MDA), interleukin-6 (IL-6) and interleukin-10 (IL-10) levels. The complications related to SGB after surgery and the postoperative pulmonary complications within 72 h were recorded.ResultsAt T1, T2, and T3, MAP levels in SGB group were lower than those in blank and control groups (P＜0.05). At T2 and T3, SGB group had lower hear rate (HR), peak airway pressure (P_peak) and tidal volume (TV) than blank and control groups (all P＜0.05). From T2 to T5, SGB group had higher OI, while lower Qs/Qt than blank and control groups (both P＜0.05). At T3 and T5, SGB group had lower SP-A, IL-6, and MDA levels but higher IL-10 and SOD levels than blank and control groups (all P＜0.05). There was one case of hypoxemia in blank group within 72 h after surgery.ConclusionUltrasound-guided SGB has lung-protective effects on patients undergoing OLV, which significantly improves patients' OI, reduces intrapulmonary shunts, declines ventilator-induced lung damage, and inhibits inflammatory response as well as oxidative stress.
Keywords:stellate ganglion block/
one-lung ventilation/
lung protection/
inflammatory response/
oxidative stress

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