星状神经节阻滞对全身麻醉手术患者术后胃肠功能恢复的影响：一项荟萃分析
Effect of stellate ganglion block on postoperative recovery of gastrointestinal function in patients undergoing surgery with general anaesthesia: a meta-analysis.
作者信息
Wen Bei, Wang Yajie, Zhang Cong, Fu Zhijian
机构信息
Department of Pain Management, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China.
Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 324 Jingwu Road, Jinan, 250021, Shandong, People's Republic of China.
出版信息
BMC Surg. 2020 Nov 16;20(1):284. doi: 10.1186/s12893-020-00943-0.
BACKGROUND
The return of gastrointestinal function is an important sign of postoperative recovery in patients undergoing surgery with general anaesthesia. We aimed to summarize the effects of stellate ganglion block on the recovery of gastrointestinal function as a means of exploring methods through which anaesthesiologists can contribute to postoperative patient recovery.
METHODS
We performed a quantitative systematic review of randomized controlled trials published between January 1, 1988, and November 11, 2019, in PubMed, the Cochrane Library, China National Knowledge Infrastructure, Chinese VIP Information, and the Wanfang and SinoMed databases. Study quality was assessed by using the GRADE criteria and bias of included studies were assessed using the revised Cochrane risk-of-bias tool for randomized trials. The time to peristaltic sound resumption, flatus, postoperative eating and the incidence of abdominal bloating in the stellate ganglion block and control groups were compared. The control group consisted of either a stellate ganglion block with normal saline or no treatment. Meta-analysis was performed using Review Manager software.
RESULTS
After searching for relevant articles, 281 studies were identified, and five articles with data on 274 patients were eligible. Regarding postoperative flatus time, stellate ganglion block resulted in a mean reduction of 15 h (P = 0.02); then a sensitivity analysis was performed, and the standard mean difference decreased to 6 h (P = 0.007). For gastrointestinal surgery, the mean reduction was 23.92 h (P = 0.0002). As for the evaluation of the recovery of peristaltic sounds, stellate ganglion block promoted the recovery of regular peristaltic bowel sounds an average of 14.67 h earlier than in the control (P = 0.0008). When it comes to nutrients, stellate ganglion block shortened the total parenteral nutrition time by more than 50 h in patients who had undergone gastrointestinal surgery (P<0.00001). Finally, stellate ganglion block prevented the occurrence of postoperative abdominal bloating (P = 0.001).) No complications related to stellate ganglion block were reported.
CONCLUSION
Stellate ganglion block may promote postoperative gastrointestinal recovery in patients undergoing various surgeries under general anaesthesia. However, additional trials investigating the use of stellate ganglion block are necessary to confirm our finding.
TRIAL REGISTRATION
This meta-analysis has been registered at the International Prospective Register of Systematic Reviews (registration number CRD42020157602).
背景
胃肠功能恢复是全身麻醉手术患者术后恢复的重要标志。我们旨在总结星状神经节阻滞对胃肠功能恢复的影响，以探索麻醉医生促进术后患者恢复的方法。
方法
我们对1988年1月1日至2019年11月11日期间发表在PubMed、Cochrane图书馆、中国知网、维普资讯、万方数据库和中国生物医学文献数据库中的随机对照试验进行了定量系统评价。采用GRADE标准评估研究质量，使用修订后的Cochrane随机试验偏倚风险工具评估纳入研究的偏倚。比较星状神经节阻滞组和对照组肠鸣音恢复时间、排气时间、术后进食时间及腹胀发生率。对照组为生理盐水星状神经节阻滞或不治疗。使用Review Manager软件进行荟萃分析。
结果
检索相关文章后，共识别出281项研究，5篇包含274例患者数据的文章符合要求。关于术后排气时间，星状神经节阻滞使平均时间缩短15小时（P = 0.02）；随后进行敏感性分析，标准平均差降至6小时（P = 0.007）。对于胃肠手术，平均缩短23.92小时（P = 0.0002）。至于肠鸣音恢复的评估，星状神经节阻滞使规律肠鸣音恢复平均比对照组早14.67小时（P = 0.0008）。在营养方面，星状神经节阻滞使胃肠手术患者的全胃肠外营养时间缩短超过50小时（P<0.00001）。最后，星状神经节阻滞预防了术后腹胀的发生（P = 0.001）。未报告与星状神经节阻滞相关的并发症。
结论
星状神经节阻滞可能促进全身麻醉下接受各种手术患者的术后胃肠功能恢复。然而，需要更多试验来研究星状神经节阻滞的应用以证实我们的发现。
试验注册
本荟萃分析已在国际前瞻性系统评价注册库注册（注册号CRD42020157602）。
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