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[星状神经节阻滞在慢性鼻窦炎合并高血压患者围手术期的疗效]

[Efficacy of stellate ganglion block in perioperative period of patients with chronic sinusitis and hypertension].

作者信息

Hu X Q, Zheng X Y, Ma W X, Jiang X

机构信息

Department of Otorhinolaryngology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China.

Department of Anesthesiology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2020 Sep 8;100(33):2591-2595. doi: 10.3760/cma.j.cn112137-20200513-01529.

Abstract

To observe the perioperative efficacy of stellate ganglion block (SGB) in functional endoscopic sinus surgery (FESS) in chronic sinusitis patients with hypertension. A total of 60 patients with chronic sinusitis complicated with hypertension who were scheduled to undergo FESS in the Department of Otorhinolaryngology, the First Affiliated Hospital of Soochow University from April 2018 to December 2019 were selected and divided into SGB group and control group by random number table method. SGB were performed at 24 hours before surgery and induction of general anesthesia alternately, while the control group was not treated. During the operation, controlled hypotension were performed in both groups. Hemodynamic parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and heart rate (HR) were recorded at 24 hours before surgery(T(0)), before anesthesia induction (T(1)), at the beginning of surgery (T(2)), at the end of surgery (T(3)), and at 24 hours after surgery(T(4)).Plasma epinephrine and norepinephrine concentrations were measured at T(0), T(1), T(3) and T(4). The dosage of anesthesia and other drugs, operative time, bleeding amount and extubation time were recorded, while the quality of the operative field was evaluated. VAS scores were assessed at 1, 6 and 24 hours after surgery. In the SGB group, SBP, DBP and MAP in T(1), T(2), T(3), T(4) and HR in T(1), T(4) were lower than those in the control group (all 0.05). Compared with T(0), SBP, DBP, MAP and HR in T(1), T(2), T(3), T(4) all decreased in SGB group (all 0.05); In the control group, SBP, DBP and MAP only decreased in T(2) and T(3), and HR fluctuated significantly (0.05). In the SGB group, plasma epinephrine and norepinephrine concentrations at T(1), T(3) and T(4) were lower than those in the control group (0.05). Compared with T(0), plasma epinephrine and norepinephrine concentrations in the SGB group fluctuated in positive and negative phases, while those in the control group increased (0.05). The pain scores in SGB group at 6 and 24 hours after surgery were 1.3±0.7 and 2.6±0.9, which were lower than 1.7±0.7 and 3.1±0.9 in the control group (-2.290, -2.050, all 0.05). SGB may effectively improve hemodynamics, maintain homeostasis, reduce anesthesia and surgical complications in patients with chronic sinusitis and hypertension in perioperative period.

摘要

观察星状神经节阻滞(SGB)在慢性鼻窦炎合并高血压患者功能性鼻内镜鼻窦手术(FESS)围手术期的疗效。选取2018年4月至2019年12月在苏州大学附属第一医院耳鼻咽喉科拟行FESS的60例慢性鼻窦炎合并高血压患者,采用随机数字表法分为SGB组和对照组。SGB组在手术前24小时和全身麻醉诱导前交替进行,对照组不进行处理。手术期间,两组均进行控制性低血压。记录手术前24小时(T(0))、麻醉诱导前(T(1))、手术开始时(T(2))、手术结束时(T(3))及手术后24小时(T(4))的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)和心率(HR)等血流动力学参数。于T(0)、T(1)、T(3)和T(4)测定血浆肾上腺素和去甲肾上腺素浓度。记录麻醉及其他药物用量、手术时间、出血量及拔管时间,同时评估术野质量。术后1、6和24小时评估视觉模拟评分(VAS)。SGB组T(1)、T(2)、T(3)、T(4)时的SBP、DBP和MAP以及T(1)、T(4)时的HR均低于对照组(均P<0.05)。与T(0)比较,SGB组T(1)、T(2)、T(3)、T(4)时的SBP、DBP、MAP和HR均降低(均P<0.05);对照组仅T(2)和T(3)时SBP、DBP和MAP降低,HR波动明显(P<0.05)。SGB组T(1)、T(3)和T(4)时血浆肾上腺素和去甲肾上腺素浓度低于对照组(P<0.05)。与T(0)比较,SGB组血浆肾上腺素和去甲肾上腺素浓度呈正负相波动,而对照组升高(P<0.05)。SGB组术后6小时和24小时疼痛评分分别为1.3±0.7和2.6±0.9,低于对照组的1.7±0.7和3.1±0.9(-2.290,-2.050,均P<0.05)。SGB可有效改善慢性鼻窦炎合并高血压患者围手术期的血流动力学,维持内环境稳定,减少麻醉及手术并发症。

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