星状神经节阻滞在老年胃癌手术患者围术期的应用研究

Application research of stellate ganglion block in perioperative period of elderly patients undergoing gastric cancer surgery

中文关键词: 老年  胃癌  星状神经节阻滞  全身麻醉  硬膜外麻醉  胃肠功能  血流动力学

英文关键词: elderly  gastric cancer  stellate ganglion block  general anesthesia  epidural anesthesia  gastrointestinal function  hemodynamics

中文摘要:

      目的 分析星状神经节阻滞(SGB)在老年胃癌根治术(RGCS)行全身麻醉(GA)联合硬膜外麻醉(EA)中的应用效果.方法 选取2022年5月-2024年5月成都市第七人民医院治疗的老年胃癌患者106例,随机分为观察组和对照组,每组53例.对照组在RGCS中行GA联合EA,观察组在与对照组相同治疗的基础上联合SGB.研究指标为T0、T1、T2、T3的心率和MAP,比较2组丙泊酚剂量、舒芬太尼剂量、苏醒时间、拔管时间、胃肠功能恢复时间,以及术前和术后24 h的炎性因子[CRP、IL-6、TNF-α]水平、应激指标[皮质醇、肾上腺素]值、认知功能和睡眠质量情况.结果 观察组T1、T2、T3时间的MAP和心率均低于对照组(P＜0.05);观察组术中丙泊酚用量、舒芬太尼用量、苏醒时间、拔管时间均少于对照组(P＜0.05);观察组患者术后排气时间、排便时间、流质食物进食时间均少于对照组(P＜0.05);观察组患者术后CRP、IL-6、TNF-α水平均低于对照组(P＜0.05);观察组患者术后肾上腺素及皮质醇水平均低于对照组(P＜0.05);观察组患者术后MMSE评分高于对照组(P＜0.05),PSQI评分低于对照组(P＜0.05).结论 老年RGCS中应用SGB,有助于维持术中心率和血压的稳定,缩短术后恢复时间,改善患者认知功能和睡眠质量.

英文摘要:

      Objective To analyze the application effects of stellate ganglion block(SGB)in elderly patients undergoing radical gastrectomy for gastric cancer(RGCS)under general anesthesia(GA)combined with epidural anesthesia(EA).Methods A total of 106 elderly patients with gastric cancer treated in Seventh People's Hospital of Chengdu City from May 2022 to May 2024 were selected and randomly divided into control group and observation group,with 53 cases in each group.The con-trol group received GA combined with EA during RGCS,while the observation group received SGB in addition to the same treat-ment as the control group.The heart rate and mean arterial pressure(MAP)at T0,T1,T2 and T3 were recorded.The doses of propofol and sufentanil,awakening time,extubation time,recovery time of gastrointestinal function,as well as the levels of in-flammatory factors(CRP,IL-6,TNF-α),the values of stress indicators(cortisol,epinephrine),cognitive function and sleep quality before the operation and 24 h after the operation were compared between the two groups.Results The MAP and heart rate of the observation group at T1,T2 and T3 were lower than those of the control group(P＜0.05).The intraoperative dosages of propofol and sufentanil in the observation group were less than those in the control group,while the awakening time and extu-bation time were shorter than those in the control group(P＜0.05).The postoperative exhaust time,defecation time and liquid food intake time in the observation group were shorter than those in the control group(P＜0.05).After the operation,the levels of CRP,IL-6 and TNF-α in the observation group were lower than those in the control group(P＜0.05),and the levels of epi-nephrine and cortisol were lower than those in the control group(P＜0.05).The MMSE score in the observation group after the operation was higher than that in the control group,and the PSQI score was lower than that in the control group(P＜0.05).Conclusion The application of SGB during RGCS for elderly patients is helpful to maintain the stability of intraoperative heart rate and blood pressure,shorten the postoperative recovery time,and improve the cognitive function and sleep quality of patients.