星状神经节阻滞对接受下肢大型骨科手术的血液透析患者动静脉内瘘的保护作用：随机对照试验

Stellate ganglion block for preserving arteriovenous fistula in hemodialysis patients undergoing major lower limb orthopedic surgeries: randomized control trial.

作者信息

Eldemrdash Ayman Mohamady, Hammad Soudy S, Hemaida Tarek S, Dardeer Taha Tairy, Mohsen Ahmed Adel, Fathy Ahmed Khalaf, Shams Gamal Hendawy

机构信息

Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Aswan University, Aswan, Egypt.

Diagnostic and Interventional Radiology Department, Faculty of Medicine, Aswan University, Aswan, Egypt.

出版信息

BMC Anesthesiol. 2025 May 31;25(1):277. doi: 10.1186/s12871-025-03150-7.

DOI:10.1186/s12871-025-03150-7

PMID:40450242

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12125875/

Abstract

BACKGROUND

Major lower limb orthopedic surgeries can lead to hemodynamic alterations and increase the risk of arteriovenous (AV)fistula thrombosis. This study assessed the role of stellate ganglion block (SGB) in preserving the AV fistulas in hemodialysis (HD)patients undergoing major lower limb orthopedic surgeries.

METHODS

In this randomized, controlled, double-blind trial, 50 chronic renal failure patients (ASA physical status III, aged 21-75 years) scheduled for major lower limb orthopedic surgeries were randomized into two groups: Group S received an ultrasound-guided SGB before spinal anesthesia, while Group C received a sham procedure. AVF function was assessed using Doppler ultrasonography on postoperative days 1 and 7. Primary outcome was AVF flow rate. Secondary outcomes included peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), thrombosis rate, and functional failure.

RESULTS

Group S demonstrated significantly higher AVF flow rates on both postoperative day 1 (276.96 ± 49.66 ml/min vs. 217.44 ± 46.73 ml/min) and day 7 (254.96 ± 49.38 ml/min vs. 204.56 ± 47.11 ml/min), with large effect sizes (Cohen's d = 1.23 and 1.04, respectively; p < 0.001). PSV and EDV were significantly improved, and RI was significantly lower in Group S. Thrombosis (8% vs. 36%) and failure rates (32% vs. 64%) were significantly reduced compared to the control group (p < 0.05).

CONCLUSIONS

Pre-emptive stellate ganglion block was associated with significantly improved AVF flow rate postoperatively and reduced thrombosis and functional failure, suggesting its clinical benefit in maintaining AVF patency during major surgeries in HD patients.

TRIAL REGISTRATION

This study was approved by the Ethical Committee of Aswan University Hospitals, Egypt (Institutional Review Board (IRB 900/2/24)) and registered on clinicaltrials.gov (ID: NCT06300658). The registration time of this experiment is 3/09/2024. The study protocol was designed and implemented in accordance with the CONSORT guidelines. The study protocol was conducted in compliance with the relevant guidelines and standards.

摘要

背景

下肢主要骨科手术可导致血流动力学改变，并增加动静脉（AV）瘘血栓形成的风险。本研究评估了星状神经节阻滞（SGB）在接受下肢主要骨科手术的血液透析（HD）患者中对保留AV瘘的作用。

方法

在这项随机、对照、双盲试验中，50例计划接受下肢主要骨科手术的慢性肾衰竭患者（ASA身体状况III级，年龄21 - 75岁）被随机分为两组：S组在脊髓麻醉前接受超声引导下的SGB，而C组接受假手术。在术后第1天和第7天使用多普勒超声评估AVF功能。主要结局是AVF流速。次要结局包括收缩期峰值流速（PSV）、舒张末期流速（EDV）、阻力指数（RI）、血栓形成率和功能衰竭。

结果

S组在术后第1天（276.96±49.66 ml/min对217.44±46.73 ml/min）和第7天（254.96±49.38 ml/min对204.56±47.11 ml/min）的AVF流速均显著更高，效应量较大（Cohen's d分别为1.23和1.04；p < 0.001）。S组的PSV和EDV显著改善，RI显著降低。与对照组相比，血栓形成率（8%对36%）和失败率（32%对64%）显著降低（p < 0.05）。