中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2011年
6期
729-731
,共3页
神经传导阻滞%星状神经节%神经外科手术%血管痉挛,颅内
神經傳導阻滯%星狀神經節%神經外科手術%血管痙攣,顱內
신경전도조체%성상신경절%신경외과수술%혈관경련,로내
Nerve block%Stellate ganglion%Neurosurgical procedures%Vasopasm,intracranial
目的 评价星状神经节阻滞对颅内动脉瘤手术患者脑血管痉挛的影响.方法 择期行颅内动脉瘤夹闭术患者40例,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将其随机分为2组(n=20):对照组(C组)和星状神经节阻滞组(SGB组).两组均常规气管内插管,静吸复合维持麻醉.SGB组气管插管后立即以0.25%罗哌卡因10ml行左侧星状神经节阻滞.分别于切皮前、夹闭动脉瘤前、夹闭动脉瘤后30 min及术毕时采集静脉血样,测定血浆内皮素、降钙素基因相关肽及S100B蛋白水平;并于术后1、3 d时采用经颅多普勒技术监测双侧大脑中动脉和颈内动脉颅外段血流速率,记录脑血管痉挛的发生情况.术后1～7 d随访患者,记录脑缺血的发生情况.结果 与c组比较,SGB组血浆内皮素和S100B蛋白浓度降低,血浆降钙素基因相关肽浓度升高,术后脑血管痉挛及脑缺血的发生率降低(P＜0.05或0.01).结论 星状神经节阻滞可抑制颅内动脉瘤手术患者脑血管痉挛的发生,其机制与抑制血管内皮细胞释放内皮素,促进降钙素基因相关肽的释放有关.
目的 評價星狀神經節阻滯對顱內動脈瘤手術患者腦血管痙攣的影響.方法 擇期行顱內動脈瘤夾閉術患者40例,ASA分級Ⅱ或Ⅲ級,採用隨機數字錶法,將其隨機分為2組(n=20):對照組(C組)和星狀神經節阻滯組(SGB組).兩組均常規氣管內插管,靜吸複閤維持痳醉.SGB組氣管插管後立即以0.25%囉哌卡因10ml行左側星狀神經節阻滯.分彆于切皮前、夾閉動脈瘤前、夾閉動脈瘤後30 min及術畢時採集靜脈血樣,測定血漿內皮素、降鈣素基因相關肽及S100B蛋白水平;併于術後1、3 d時採用經顱多普勒技術鑑測雙側大腦中動脈和頸內動脈顱外段血流速率,記錄腦血管痙攣的髮生情況.術後1～7 d隨訪患者,記錄腦缺血的髮生情況.結果 與c組比較,SGB組血漿內皮素和S100B蛋白濃度降低,血漿降鈣素基因相關肽濃度升高,術後腦血管痙攣及腦缺血的髮生率降低(P＜0.05或0.01).結論 星狀神經節阻滯可抑製顱內動脈瘤手術患者腦血管痙攣的髮生,其機製與抑製血管內皮細胞釋放內皮素,促進降鈣素基因相關肽的釋放有關.
목적 평개성상신경절조체대로내동맥류수술환자뇌혈관경련적영향.방법 택기행로내동맥류협폐술환자40례,ASA분급Ⅱ혹Ⅲ급,채용수궤수자표법,장기수궤분위2조(n=20):대조조(C조)화성상신경절조체조(SGB조).량조균상규기관내삽관,정흡복합유지마취.SGB조기관삽관후립즉이0.25%라고잡인10ml행좌측성상신경절조체.분별우절피전、협폐동맥류전、협폐동맥류후30 min급술필시채집정맥혈양,측정혈장내피소、강개소기인상관태급S100B단백수평;병우술후1、3 d시채용경로다보륵기술감측쌍측대뇌중동맥화경내동맥로외단혈류속솔,기록뇌혈관경련적발생정황.술후1～7 d수방환자,기록뇌결혈적발생정황.결과 여c조비교,SGB조혈장내피소화S100B단백농도강저,혈장강개소기인상관태농도승고,술후뇌혈관경련급뇌결혈적발생솔강저(P＜0.05혹0.01).결론 성상신경절조체가억제로내동맥류수술환자뇌혈관경련적발생,기궤제여억제혈관내피세포석방내피소,촉진강개소기인상관태적석방유관.
Objective To evaluate the effect of stellate ganglion block (SGB) on cerebral vasospasm in patients undergoing intracranial aneurysm surgery. Methods Forty ASA Ⅱ or Ⅲ patients aged 14-64 yr weighing 40-81 kg undergoing intracranial aneurysm clipping were randomly divided into 2 groups ( n = 20 each): group control (group C) and group SGB. Left SGB was performed with 0.25% ropivacaine 10 ml immediately after intubation. Successful block was verified by development of Homer syndrome within 15 min after block. Anesthesia was induced with midazolam, propofol, fentanyl and vecuronium and maintained with isoflurane inhalation and intermittent iv boluses of fcntanyl and vecuronium. The patients were intubated and mechanically ventilated. PETCO2 was maintained at 30-35 mm Hg. BIS was maintained at 50-60. Right internal jugular vein was cannulated and the catheter was threaded cranially until resistance was met for blood sampling. Blood samples were collected before skin incision (T1), before clipping of aneurysm (T2), at 30 min after clipping (T3 ), and at the end of surgery (T4) for determination of plasma concentrations of endothelin (ET), calcium gene-related peptide (CGRP) and S100B protein. Transcranial Doppler was used to measure the flow rate of blood in bilateral middle cerebral artery and extracranial carotid artery at 1 and 3 days after surgery. All patients were observed for incidence of brain ischemia during 1-7 days after surgery. Results Plasma ET and S100B protein concentrations were significantly decreased, while plasma CGRP concentration was significantly increased after clipping of aneurysm at T3 and T4 in group SGB as compared with group C. The incidence of cerebral vasospasm and brain ischemia was significantly lower in group SGB than in group C. Conclusion SGB performed before operation can significantly reduce the incidence of cerebral vasospasm after clipping of intracranial aneurysm by inhibiting the release of ET and promoting the release of CGRP.
