Zhu Guoshao, Su Changsheng, Kang Zhenming, Zeng Jingyang, Li Shunyuan
Department of Anesthesiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China.
Front Surg. 2024 Dec 23;11:1438146. doi: 10.3389/fsurg.2024.1438146. eCollection 2024.
Single-lung ventilation (SLV) is a widely used procedure in thoracic surgery; however, it can lead to hypoxemia, which is attributed to intrapulmonary shunt and hypoxic pulmonary vasoconstriction. Stellate ganglion blockade (SGB) has shown protective effects during SLV in various pulmonary conditions. The objective of the study was to assess the clinical utility of ultrasound-guided SGB in patients undergoing thoracoscopic pulmonary lobectomy through a prospective clinical trial.
This prospective randomized controlled double-blind trial included 116 patients who underwent SLV. After exclusion, 88 patients were randomly assigned to either the SGB group ( = 40) or control group ( = 39), with the latter receiving no SGB. Hemodynamics using oxygenation index (OI) and the pulmonary shunt fraction (Qs/Qt), respiratory mechanics using dynamic lung compliance (Cdyn) and mean airway pressure (P), and levels of pro-inflammatory factors (IL-6 and IL-8) were assessed as clinical outcomes after surgery.
SLV induced upregulation of P, Qs/Qt, and levels of IL-6 and IL-8 and downregulation of Cdyn and OI. Compared to the control group, the SGB group demonstrated significantly decreased P, Qs/Qt, IL-6, and IL-8 and increased Cdyn and OI, suggesting the protective effects of SGB in patients who received SLV.
Ultrasound-guided SGB improves respiratory mechanics, hemodynamics, and inflammatory responses during SLV. Our findings suggest a protective role of SGB in reducing complications associated with SLV.
The study was registered in the Chinese Clinical Trial Registry (#ChiCTR2200063210).
单肺通气（SLV）是胸外科手术中广泛应用的操作；然而，它可导致低氧血症，这归因于肺内分流和低氧性肺血管收缩。星状神经节阻滞（SGB）在各种肺部疾病的单肺通气期间已显示出保护作用。本研究的目的是通过一项前瞻性临床试验评估超声引导下SGB在接受胸腔镜肺叶切除术患者中的临床应用价值。
这项前瞻性随机对照双盲试验纳入了116例行单肺通气的患者。排除后，88例患者被随机分为SGB组（n = 40）或对照组（n = 39），后者不接受SGB。术后评估使用氧合指数（OI）和肺分流分数（Qs/Qt）的血流动力学、使用动态肺顺应性（Cdyn）和平均气道压（P）的呼吸力学以及促炎因子（IL-6和IL-8）水平作为临床结局。
单肺通气导致P、Qs/Qt以及IL-6和IL-8水平上调，Cdyn和OI下调。与对照组相比，SGB组的P、Qs/Qt、IL-6和IL-8显著降低，Cdyn和OI升高，表明SGB对接受单肺通气的患者具有保护作用。
超声引导下SGB可改善单肺通气期间的呼吸力学、血流动力学和炎症反应。我们的研究结果表明SGB在减少与单肺通气相关并发症方面具有保护作用。
该研究已在中国临床试验注册中心注册（#ChiCTR2200063210）。
