【摘要】 目的 观察右星状神经节阻滞（R-SGB）对全身麻醉气管内插管期心血管反应的影响。 方法 2009年10-12月选取60例美国麻醉医师协会（ASA）Ⅰ、Ⅱ级择期全麻手术患者，随机分为3组。研究组于全麻诱导前15 min用1%利多卡因10 mL经颈6入路行R-SGB，对照组1诱导前同法注射10 mL生理盐水，对照组2诱导前肌注2%利多卡因5 mL。观察气管插管前后收缩压（SBP）、舒张压（DBP）、平均动脉压（MBP）、心率（HR）、心电图（ECG）、氧饱和度（SpO2）和心率收缩压乘积（RPP）的变化。 结果 研究组各时点与进入手术室时的基础值比较，仅诱导后SBP、DBP、MBP显著降低，窥喉时HR和RPP显著升高（Plt;0.01）；在插管3 min后已恢复至基础值。对照组1和对照组2诱导后SBP、DBP、MBP显著降低（Plt;0.01）；窥喉时SBP、DBP、MBP、HR、RPP均显著升高（Plt;0.01），并持续至插管后5 min。两对照组升高的程度均显著高于研究组（Plt;0.05或Plt;0.01）。 结论 R-SGB对全麻气管插管期的心血管反应有一定抑制作用，可用于调控全麻插管期心血管不良反应。【Abstract】 Objective To explore the effect of right stellate ganglion block (R-SGB) on cardiovascular response during endotracheal intubation under the general anesthesia. Methods Sixty ASAⅠ-Ⅱpatients who underwent general anaesthesia between October to December 2009 were randomly divided into three groups. The patients in the trial group accepted R-SGB by C6 route with 1% lidocaine (10 mL) 15 minutes before induction of general anesthesia; the patients in control group 1 were injected with 10 mL physiological saline in the same way before the induction; the patients in control group 2 underwent the intramuscular injection of 2% lidocaine (5 mL) before the induction. The changes of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), hear rate (HR), electrocardiogram (ECG), oxygen saturation (SpO2) and heart rate-systolic blood pressure product (RPP) before and after endotracheal intubation were observed and recorded. Results In the trial group, SBP, MAP, and DBP decreased significantly after the induction; HR and RPP increased evidently at the laryngeal exposure compared with the baseline values (Plt;0.01) and recovered three minutes after the intubation. In the control group 1 and 2, SBP, MAP, and DBP decreased significantly after induction (Plt;0.01); SBP, MAP, DBP, HR and RPP increased apparently at the laryngeal exposure compared with the baseline values (Plt;0.01), and the raise continued until five minutes after endotracheal intubation. The difference in the raise between the control groups and the trial group was significant (Plt;0.05 or Plt;0.01). Conclusion R-SGB may effectively inhibit the cardiovascular response during endotracheal intubation under the general anesthesia and can be used to control the negative reaction during the induction.
The present study was to examine the effect of stellate ganglion block (SGB) on bilateral regional cerebral oxygen saturation (rSO2) and postoperative cognitive function. Eighty patients undergoing selective coronary artery bypass graft with cardiopulmonary bypass (CPB) were randomly and equally divided into two groups. The patients in group S were given right SGB with ropivacaine, while the patients in group C were injected with normal saline. We compared the bilateral rSO2 after SGB. Minimum Mental State Examination (MMSE), Visual Verbal Learning Test (VVLT), and Digital Span Test (DST) were applied to observe the effect on cognitive function. We found that the incidence of postoperative cognitive dysfunction (POCD) 7 days after surgery in group S was lower than that in group C. The level of blocked side rSO2 of S group were significantly higher before CPB time of rewarming than that before SGB (P＜0.05), much higher than corresponding non-blocked side rSO2 before CPB (P＜0.05), and much higher than rSO2 level in group C before CPB and after CPB(P＜0.05). The non-blocked side rSO2 in group S before anesthesia were much lower than basic levels and those in group C (P＜0.05). It could be concluded from the above results that there was significant increase in the blocked-side rSO2 compared to the non-blocked side and there was significant decrease in the incidence of POCD compared to the control group after SGB.