本文選題：胃腸道手術(shù) + 星狀神經(jīng)節(jié)阻滯　； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:本研究的目的是探討超聲引導(dǎo)下單側(cè)星狀神經(jīng)節(jié)阻滯(stellate ganglion block,SGB)對胃腸道手術(shù)患者圍術(shù)期炎癥反應(yīng)及術(shù)后胃腸道功能恢復(fù)的作用。方法:本課題前瞻性地納入了 69名行胃腸道手術(shù)患者,按1:2比例隨機(jī)分組。最終,SGB組有18例患者、對照組有42例患者完成研究并納入統(tǒng)計(jì)分析。在超聲引導(dǎo)下,SGB組于左側(cè)第六頸椎水平以7ml 0.5%羅哌卡因行星狀神經(jīng)節(jié)阻滯,對照組于同一部位在星狀神經(jīng)節(jié)處注射7ml生理鹽水。采集兩組病人SGB前(0h)、SGB后2h、SGB后4h及SGB后24h的外周血,分析比較兩組病人這四個(gè)時(shí)間點(diǎn)的TNF-α、IL-1β、IL-6等細(xì)胞因子水平。同時(shí)采集SGB前和SGB后第一天的白細(xì)胞、血小板、膽紅素、肌酐水平等臨床數(shù)據(jù)以及患者術(shù)后腸鳴音和肛門/造口排氣的恢復(fù)時(shí)間。結(jié)果:SGB組的TNF-α水平在SGB后2h、4h及IL-1β水平在SGB后2h、24h明顯低于對照組(P0.05),IL-6水平與對照組無明顯差異。SGB組術(shù)后白細(xì)胞計(jì)數(shù)上升水平小于對照組(SGB組平均升高水平為4.05±4.03×109/LVS對照組平均升高水平為6.37±3.35×109/L,P0.05)。兩組的膽紅素、肌酐及血小板計(jì)數(shù)水平無明顯差異。在術(shù)后胃腸道功能恢復(fù)方面,SGB組術(shù)后腸鳴音恢復(fù)時(shí)間(SGB組46.22±31.02小時(shí)VS對照組72.27±35.70小時(shí),P0.05)及肛門/造口排氣時(shí)間(SGB組65.78±33.93小時(shí)VS對照組94.40±43.38小時(shí),P0.05)明顯低于對照組。結(jié)論:對于胃腸道手術(shù)患者,SGB可抑制TNF-α、IL-1β等細(xì)胞因子的表達(dá),降低術(shù)后白細(xì)胞水平的增幅,以及縮短術(shù)后腸鳴音和肛門/造口排氣的恢復(fù)時(shí)間。提示SGB有助于改善此類患者的圍術(shù)期炎癥反應(yīng),并促進(jìn)術(shù)后胃腸道功能的恢復(fù)。
[Abstract]:Objective: to investigate the effect of (stellate ganglion block guided by ultrasound on perioperative inflammatory reaction and gastrointestinal function recovery in patients undergoing gastrointestinal surgery. Methods: 69 patients undergoing gastrointestinal surgery were prospectively divided into groups at 1:2. Finally, there were 18 patients in the SGB group and 42 patients in the control group. 7ml 0.5% ropivacaine planetary ganglion was used to block the sixth cervical vertebra in the SGB group under the guidance of ultrasound, while the control group was injected with 7ml saline at the stellate ganglion at the same position. The levels of cytokines such as TNF- 偽 IL-1 尾 and IL-6 were collected from peripheral blood of two groups of patients before (0 h), 2 h after SGB and 24 h after SGB, respectively. At the same time, the clinical data of white blood cells, platelets, bilirubin and creatinine were collected before and on the first day after SGB. Results the levels of TNF- 偽 and IL-1 尾 in the control group were significantly lower than those in the control group (P0.05). The increase level of leukocyte count in the SGB group was lower than that in the control group (4.05 鹵4.03 脳 10 9 / LVS) (the average level of increase was 4.05 鹵4.03 脳 10 9 / LVS) in the control group (4. 05 鹵4. 03 脳 10 9 / LVS). The average elevation was 6.37 鹵3.35 脳 10 ~ 9 / L (P0.05). There was no significant difference in bilirubin, creatinine and platelet count between the two groups. The recovery time of postoperative bowel sounds in SGB group (46.22 鹵31.02 hours vs control group, 72.27 鹵35.70 hours, P0.05) and anal / orifice venting time (SGB group, 65.78 鹵33.93 hours vs 94.40 鹵43.38 hours, P0.05) were significantly lower than those in control group. Conclusion: SGB can inhibit the expression of cytokines such as TNF- 偽 and IL-1 尾, decrease the increase of leukocyte level after operation, and shorten the recovery time of bowel sound and anus / orifice exhaust. The results suggest that SGB can improve the perioperative inflammatory reaction and promote the recovery of gastrointestinal function.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

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本文編號：2081760